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ITS 


CAUSE  AND  TREATMENT 


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CANCER 

ITS 
CAUSE  AND  TREATMENT 


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CANCER 

ITS 

CAUSE  AND  TREATMENT 

BY 
L.  DUNCAN  BULKLEY,  A.M.,  M.D. 

Senior  Physician 
The  New  York  Skin  and  Cancer  Hospital,  etc. 


NEW  YORK 
PAUL  B.   HOEBER 

1915 


Copyright,  1915 
By  PAUL  B.  HOEBER 


Published^  February ,  1915 


Printed  in  U.  S.  A. 


To 

THE  GOVERNORS 

of  the 

NEW  YOBK   SKIN   AXD   CAXCER  HOSPITAL 

whose  kind  appreciation  of  and  assistance  to  the  author 
in  his  clinical  work  in  their  institution  have 
done  much  to  encourage  him  and  to 
promote  the  interest  of  the  pro- 
fession in  the  branch  of 

DERMATOLOGY 

this   little  book  is    inscribed 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/canceritscausetr01bulk 


PREFACE 

Cancer  has  hitherto  been  regarded  almost 
wholly  from  its  histological  and  surgical 
aspects.  The  investigators  and  practi- 
tioners along  these  lines  have  been  innu- 
merable, the  work  done  prodigious,  and  the 
literature  relating  thereto  enormous.  But 
relatively  little  attention  has  been  paid  to 
the  medical  aspects  of  this  most  threaten- 
ing malady,  although  voices  have  been 
raised  from  time  to  time,  with  more  or  less 
force,  all  joining  in  the  same  plea  that  the 
basic  cause  of  the  disease  lies  in  some  de^ 
rangement  in  the  vital  forces  of  the  organ^ 
ism,  as  influenced  largely  by  diet  and  mode 
of  life. 

It  has,  therefore,  seemed  to  the  writer 
that  it  was  time  to  stop  and  look  at  cancer 
from  a  broader  aspect,  and  by  synthesis 

7 


8  PEEFACE 

and  deduction  to  seek  to  understand  some 
of  the  underlying  causes  of  malignant  dis- 
ease ;  also  to  see  if  some  general  principles 
could  not  be  ascertained  upon  wliicli  could 
be  based  an  explanation  of  the  views  he 
had  long  held,  and  of  the  practice  which  he 
had  long  followed  in  regard  to  the  preven- 
tion and  cure  of  this  dire  malady.  And 
as  his  studies  progressed  he  was  more  and 
more  satisfied  that  the  true  solution  of  the 
cancer  problem  lay  along  the  lines  indi- 
cated, although  there  was  still  very  much 
to  be  learned  regarding  the  details  and  ap- 
plication of  the  principles  involved. 

The  lectures  were  prepared  for  and  de- 
livered to  practicing  physicians  at  the  New 
York  Skin  and  Cancer  Hospital,  in  con- 
nection with  the  regular  Wednesday  lec- 
tures on  Diseases  of  the  Skin,  as  I  felt  that 
I  should  give  them  the  benefit  of  what  I 
felt  to  be  of  value  in  my  own  practice,  pri- 
vate and  public. 

Although    holding   the   views   here    ex- 


PREFACE  9 

pressed  for  many  years  I  have  hesitated 
writing  strongly  on  the  subject  before,  lest 
I  should  be  misunderstood  or  misjudged: 
for  favorable  results  based  solely  on  a 
clinical  diagnosis  of  cancer  are  always 
doubted.  I  have  also  feared  lest  by  advo- 
cating a  dietetic  and  medical  consideration 
and  treatment  of  cancer,  which  possibly 
might  not  be  carried  out  exactly,  I  might 
really  do  harm ;  since  some  might  be  led  to 
neglect  operative  measures  in  proper  cases, 
at  the  proper  time;  and  so  in  certain  in- 
stances great  injury  and  injustice  might  be 
done  to  the  patient,  and  the  time  pass  in 
which  a  surgical  operation  might  possibly 
be  of  service. 

But  with  my  views  and  experience, 
strengthened  greatly  by  what  studies  I 
have  been  able  to  make  in  the  midst  of  a 
busy  professional  life,  I  now  feel  that  I 
should  do  wrong  in  not  presenting  the  re- 
sults and  conclusions  of  my  study  and  ob- 
servation.    And  I  wish  also  to  enter  my 


10  PREFACE 

strong  protest  against  the  course  which  is 
usually  followed  in  regard  to  cancer,  both 
before  and  after  operation.  With  a  rather 
extended  experience  during  the  last  forty 
years,  I  have  rarely  if  ever  found  a  patient 
with  cancer  who  has  received  adequate  and 
continuous  medical  care  before  operation, 
with  a  view  of  discovering  and  rectifying 
the  cause  of  the  morbid  growth.  Too  often 
when  a  cancer  is  suspected  or  discovered 
it  is  taken  as  a  foregone  conclusion  that 
the  malady  is  hopeless,  except  as  the  re- 
sults of  the  disease^  that  is  the  new  growth, 
may  be  removed  by  the  knife,  X-ray,  ra- 
dium, caustics,  etc.  And  after  a  surgical 
operation,  as  far  as  my  observation  goes, 
the  patients  are  invariably  left  entirely  to 
their  own  resources,  with  the  hope,  alas, 
too  often  futile,  that  the  tumor  will  not 
regrow,  but  with  no  attempt  to  so  guide 
the  life  that  there  shall  not  be  the  same 
tendency  to  a  recurrent  malignant  new- 


PREFACE  11 

formation.  Against  this  latter  course  I 
also  raise  my  earnest  protest. 

In  presenting  matter  from  literature 
bearing  on  the  subject  under  discussion  I 
am  well  aware  that  I  have  hardly  more 
than  touched  the  surface  of  the  deep  ocean 
of  recorded  observations  on  cancer,  but  it 
was  the  best  that  I  could  do  in  my  busy 
life.  I  only  hope  that  others  will  take  up 
in  earnest  the  subjects  here  presented,  and 
that  this  pioneer  work  may  lead  to  the 
building  of  a  strong  and  permanent  struc- 
ture regarding  the  true  basic  cause  of  can- 
cer.    Truth  never  fears  proof. 

In  studying  the  subject  I  have  been 
greatly  assisted  by  the  masterful  work  of 
Roger  Williams,  so  often  referred  to  and 
quoted  from;  and  I  feel  that  a  candid  and 
careful  perusal  of  that  book  will  be  a  reve- 
lation to  many.  I  know  that  some  have 
endeavored  to  throw  discredit  upon  some 
of  the  deductions  which  he  makes  from 


12  PREFACE 

various  statistics,  but  in  the  main  tliey  all 
teach  a  valuable  lesson  and  are  worth  seri- 
ous consideration,  as  they  are  taken  from 
reliable  sources. 

Eealizing  fully  that  the  problem  of  the 
cause  and  proper  treatment  of  cancer  is  a 
most  profound  one,  which  master  minds 
have  long  wrestled  with  and  which  cannot 
be  fully  settled  without  much  further 
study,  these  lectures  are  presented  to  the 
profession  at  large  in  the  hope  that  they 
may  be  the  means  of  helping  some  one 
threatened  with  or  suffering  from  malig- 
nant disease;  and  also  that  they  may  pos- 
sibly stimulate  others  to  investigate  even 
more  diligently  along  the  lines  of  the 
medical  aspects  of  cancer. 

January,  1915. 

531  Madison  Avenue. 


CONTENTS 

PAGE 

LECTURE  I 
Nature    of    Cancer 15 

LECTURE  II 

Frequency    and    C4eographical    Distribution    of 

Cancer 43 

LECTURE  III 
Metabolism  of  Cancer     .      . 70 

LECTURE  IV 
Relation  of  Diet  to  Cancer 106 

LECTURE  V 
Medical  Treatment  of  Cancer   .      .      .      .      .      .135 

LECTURE  VI 
Clinical   Considerations   and   Conclusions  .      .170 

Bibliography 211 

Index 221 


CANCER 

ITS 

CAUSE  AND  TREATMENT 

LECTUEE  I 

NATUEE   OF    CANCER 

It  may  be  safely  said  tliat  no  disease  which 
has  afflicted  mankind  has  received  as  much 
attention  as  Cancer,  or  concerning  which 
there  has  been  as  much  diligent  search  to 
find  out  its  nature  and  cause.  Tubercu- 
losis, which  seemed  at  one  time  to  threaten 
even  the  existence  of  the  race,  has  sunk 
into  relative  significance,  as  we  have 
learned  its  true  nature  and  conquered  some 
of  the  causes  of  its  ravages,  and  reduced 
its  mortality  very  largely.  Syphilis,  un- 
der various  names,  forms,  and  aspects,  was 
formerly  much  more  of  a  menace  than  now, 

15 


16   MEDICAL  ASPECTS  OF  CANCER 

and  in  earlier  years  caused  veritable  epi- 
demics, but  is  now  well  understood  and  con- 
trolled. Leprosy  is  less  of  a  terror  than 
in  earlier  times,  since  it  has  been  definitely 
shown  not  to  be  contagious.  Smallpox  no 
longer  rages,  and  yellow  fever,  and  the 
plague,  and  hook  worm  disease  have  been 
hunted  down  by  scientific  study  and  the 
application  of  proper  sanitary  and  medical 
measures.  And  so  on  in  regard  to  many 
of  the  ills  which  afflict  mankind. 

But  cancer  has  held  its  own  and  has 
even  increased  in  frequency,  with  rapid 
strides  and  bounds  in  some  localities,  until 
now  it  looms  large  as  a  national  ^  or  even 
universal  scourge ;  it  has  been  estimated  to 
cause  the  death  of  half  a  million  persons 
yearly  among  the  civilized  people  of  the 

1  According  to  the  United  States  Mortality  tables  for 
1912  there  were  44,531  deaths  from  cancer  that  year,  or 
77  per  100,000  living,  while  the  rate  in  1911  was  74.3, 
an  increase  of  2.7.  Tuberculosis  has  shown  a  steady 
decline,  the  death  for  1912  being  the  lowest  on  record, 
149.5  per  100,000,  it  having  fallen  from  200  per  100,000 
in  1900,  or  over  25%. 


NATURE  OF  CANCER  17 

earth,  and  untold  misery  and  suffering  to 
many  times  this  number.  And  all  this  is 
still  going  on  in  spite  of  the  earnest,  faith- 
ful, and  intelligent  labors  of  innumerable 
research  workers,  the  sacrifice  of  countless 
animal  lives,  and  the  expenditure  of  vast 
sums  of  money;  and  the  end,  as  far  as  re- 
lates to  its  prevention  and  cure,  seems  al- 
most as  far  away  as  ever,  for  many  sur- 
geons, in  past  and  present  times,  have 
acknowledged  their  inability  to  cope  with 
the  disease. 

Much,  however,  has  already  been  estab- 
lished by  scientific  research,  and  still  more 
earnest  thought,  observation,  and  endeavor 
should  be  given  to  seeking  most  diligently 
for  the  cause  of  the  disease,  in  the  labora- 
tory as  well  as  in  practice ;  for  there  must 
be  some  cause  of  cancer,  and  also  some 
reason  for  its  steady  increase. 

But  it  is  never  to  be  forgotten  that,  as 
Pope  says,  ^'the  proper  study  of  mankind 
is   man,''   and   clinical   observation,   with 


18   MEDICAL  ASPECTS  OF  CANCER 

laboratory  research,  on  cancer  as  it  ap- 
pears in  the  human  being,  must  be  the  ulti- 
mate base  upon  which  all  true  advance  in 
the  knowledge  of  the  nature,  treatment, 
and  prevention  of  the  malady  can  ever  rest. 
To  effect  this  we  must  study  the  human 
being  in  all  relations  of  life,  must  know  the 
constitution  and  class  of  subjects  in  which 
the  disease  is  most  apt  to  manifest  itself, 
understand  the  chemico-physiologic  actions 
going  on  in  the  system,  before  and  during 
the  existence  of  the  disease,  and  by  a  proc- 
ess of  synthesis  and  deduction  understand 
what  is  wrong  and  endeavor  to  correct  it. 
All  this  is  indeed  a  great  undertaking, 
and  can  only  be  accomplished  by  great  ef- 
fort on  the  part  of  many  careful  and  skilled 
observers.  But  I  want,  in  these  lectures,  to 
give  you  an  outline  of  my  own  thought  and 
study  for  many  years,  and,  if  possible,  to 
let  you  see  as  I  do  the  lines  along  which 
investigation  should  be  directed.  It  is 
hoped,  therefore,  that  this  and  the  follow- 


NATURE  OF  CANCER  19 

ing  lectures  will  throw  some  light  on  the 
connection  of  cancer  with  diet  and  mode 
of  life,  and  some  suggestions  as  to  its  pre- 
vention and  cure. 

Parasitism  has  been  excluded:  for  while 
at  different  times  many  observers  have  re- 
ported various  organisms  which  were 
thought  to  be  the  cause  of  malignant 
growths,  none  of  these  have  been  definitely 
confirmed  by  others,  in  spite  of  earnest 
endeavor ;  and  all  experimental  and  clinical 
evidence  is  against  a  parasitic  etiology  of 
cancer.  It  is  therefore  seen  how  improper 
it  is  to  speak  any  longer  of  ^Hhe  germ  of 
caiicer/'  for,  as  is  now  widely  acknowl- 
edged, there  is  no  such  germ,  it  is  an  ig^iis 
fatuus  which  has  been  chased  in  vain. 

The  contagiousness  of  cancer  has  also 
been  excluded,  certainly  in  the  sense  in 
which  this  term  is  applied  to  other  affec- 
tions. For  while  in  some  animals  inocu- 
lation experiments  have  resulted  in  the 
transmission  of  certain  tumors,  little  has 


20   MEDICAL  ASPECTS  OF  CANCER 

been  determined  except  that  such  tumor 
material  when  transplanted  can,  in  some 
unknown  manner,  multiply  its  cells  in- 
definitely and  form  a  focus  of  malig- 
nant disease,  with  disastrous  effects  on 
adjoining  tissue.  The  same  occurs  in 
metastasis  in  cancer  patients.  But  this 
does  not  at  all  explain  the  true  basic 
nature  of  cancer,  nor  its  development  in 
those  who  have  had  no  connection  with 
other  patients  so  afflicted.  On  the  other 
hand  the  instances  of  suggested  or  sup- 
posed human  transmission  of  cancer  from 
one  individual  to  another  are  so  remark- 
ably few,  and  so  exceedingly  doubtful,  that 
a  recent  author,  Janeway,  states  that  *^no 
well-authenticated  cases  of  the  transfer  of 
a  malignant  tumor  from  one  human  being 
to  another  exist.''  It  has  been  found  im- 
possible to  inoculate  human  cancer  into 
rats,  mice,  and  apes,  nor  can  animal  tumors 
be  inoculated  into  animals  of  a  different 

species. 
Heredity  has  been  advanced  as  a  cause, 


NATURE  OF  CANCER  21 

but  statistics  fail  to  verify  this  in  any  de- 
gree whatever.  While  certain  instances 
have  been  brought  forward  in  whieh  hered- 
ity seemed  evident,  the  study  of  large  num- 
bers of  those  afflicted  with  cancer,  in  con- 
nection with  others  free  from  the  disease, 
has  shown  almost  the  same  proportion  of 
antecedents  with  cancer  in  both  classes  of 
persons;  although  some  recent  evidence 
seems  to  show  that  there  is  some  tendency 
in  different  families  for  different  organs. 
Experimental  studies  have,  it  is  true, 
seemed  to  demonstrate  that  tumors  occur 
apparently  along  hereditary  lines  in  some 
animals  in  regard  to  certain  organs;  but 
in  these  instances  it  is  to  be  remembered 
that  the  animals  were  kept  in  captivity,  and 
all  fed  alike,  conditions  which  have  been 
found  to  cause  the  development  of  malig- 
nant disease  in  wild  animals  when  confined 
in  Zoological  Gardens. 

In  former  years  malaria  was  believed  to 
have  an  influence  in  the  production  of  can- 


22   MEDICAL  ASPECTS  OF  CANCER 

cer,  and  some  investigators  have  thought  to 
trace  the  prevalence  of  the  disease  to  tel- 
luric influences,  showing  a  preponderance 
of  cases  along  certain  water  courses,  or  in 
certain  streets  or  houses;  but  no  definite 
proof  of  such  connection  has  ever  been  es- 
tablished, and  this  theory  is  dismissed  by 
the  best  authorities.  Syphilis,  in  its  latent 
effects,  has  also  been  claimed  as  an  element 
in  the  causation  of  cancer,  and  undoubtedly 
the  disease  may  develop,  in  suitable  per- 
sons, upon  old  syphilitic  lesions,  especially 
about  the  mouth,  anus,  and  genital  region : 
but  no  one  well  informed  in  regard  to  can- 
cer would  regard  syphilis  as  the  real  cause 
of  the  disease.  All  these  and  other  etio- 
logical propositions  are  no  longer  consid- 
ered to  be  tenable,  and  the  very  multiplicity 
of  suggested  causes  shows  that  we  are  yet 
very  far  from  the  true  etiology  of  cancer. 
Age  undoubtedly  has  a  powerful  influ- 
ence in  the  development  of  cancer,  the  vast 
majority  of  cases  occurring  after  the  age 


NATURE  OF  CANCER  23 

of  forty  or  fifty.  But,  again,  this  does  not 
at  all  exjDlain  the  true  nature  of  the  disease, 
for  only  a  certain  proportion  of  elderly 
people  are  so  afflicted,  and  malignant 
tumors  have  been  observed  in  those  of  all 
ages,  and  even  in  young  children.  The  de- 
generation of  tissue  belonging  to  advancing 
years  undoubtedly  renders  it  more  suscep- 
tible to  malignant  disease,  but  this  does  not 
explain  why  one  person  is  affected  and  not 
another,  nor  why  the  tissues  in  one  locality 
or  another  take  on  this  morbid  action. 

More  recent  scientific  study  has  at- 
tempted to  show  that  cancer  originates 
from  what  are  called  "embryonic  rests/' 
or  pre-natal,  wrongly  placed,  tissue  ele- 
ments, which  at  some  time  or  other  take 
on  morbid  action  and  develop  into  what 
we  know  as  the  various  forms  of  cancer. 
"Williams  says,  ^'From  a  biological  stand- 
point tumor  formation  must  be  regarded  as 
a  phenomenon  of  the  same  order  as  repro- 
duction in  general :  that  is  to  say,  as  a  spe- 


24   MEDICAL  ASPECTS  OF  CANCER 

cial  form  of  overgrowth  of  the  individual. '  * 
But  here  again  it  is  necessary  to  determine 
what  causes  them  at  certain  times  and  in 
certain  places  to  thus  proliferate  and  form 
new  tissue,  which  then  becomes  malignant 
and  may  proceed  to  destroy  all  contiguous 
tissues,  and  even  to  cause  death. 

Traumatism  has  been  claimed  by  many 
as  the  cause  which  determines  the  activitv 
of  the  misplaced  cells,  and  starts  them  on 
their  disastrous  or  rampant  course:  the 
various  percentages  of  the  cases  in  which 
it  was  believed  that  traumatism  started  up 
the  malignant  process  has  varied  greatly 
with  different  observers,  even  up  to  50  per 
cent,  or  more.  But  it  is  far  from  proven 
that  this  is  always  the  case,  nor  does  local 
injury  in  any  way  explain  the  persistency 
with  which  malignant  disease,  when  once 
started,  pursues  its  destructive  and  even 
fatal  career;  nor  can  traumatism  account 
for  the  great  tendency  to  recurrence  con- 
stantly observed,  either  in  the  former  site 


NATURE  OF  CANCER  25 

or  at  some  distant  focus,  through  the 
agency  of  the  lymphatic  or  vascular  system. 
For  of  multitudinous  traumatisms,  even  in 
cancer  subjects,  how  few  ever  develop  into 
malignant  disease ! 

It  would  seem,  therefore,  that  for  the  de- 
velopment of  the  local  manifestation  of 
cancer  (the  tumor  or  new  growth)  three 
elements  are  requisite,  namely :  1.  A  pre- 
disposition or  suitable  blood  condition.  2. 
A  local  stimulation  or  irritation  of  the 
part  affected,  upon,  3.  The  site  of  an 
*^ embryonic  rest.'' 

On  the  basis  of  the  embryonic  theory 
surgeons  have  of  late  most  earnestly  advo- 
cated the  very  early  and  complete  removal 
of  malignant  lesions,  including  those  of 
suspected  malignancy,  and  even  also  the 
removal  of  many  innocent  lesions  which 
are  observed  occasionally  to  lead  to  can- 
cerous formation ;  and  unless  a  better  plan 
can  be  determined  this  cannot  be  urged 
too  strongly  in  proper  cases. 


26   MEDICAL  ASPECTS  OF  CANCER 

But  while  early  operation  lias  improved 
surgical  statistics,  it  has  not  contributed 
to  our  real  knowledge  of  the  basic  cause 
of  cancer,  nor  has  it  taught  us  why  those 
lesions  or  '^embryonic  rests"  will  remain 
quiescent  for  years,  or  prove  harmless  in 
some  individuals,  while  in  others  they  be- 
come most  formidable  agents  of  destruc- 
tion. For  it  is  now  recognized  that  these 
wrongly  placed  tissue  elements  are  very 
common  anatomical  or  histological  acci- 
dents, indeed  it  is  claimed  that  they  occur 
and  exist  in  every  individual:  and  the 
removal  of  isolated  '^embryonic  rests" 
which  have  developed  into  cancer,  does  not 
by  any  means  prevent  the  transformation 
of  other  similarly  misplaced  cells  into  ma- 
lignant disease,  as  the  frequent  recurrence 
of  cancer  after  operation  demonstrates. 

The  same  is  true  of  the  many  and  vari- 
ous forms  of  treatment  other  than  surgical 
excision,  such  as  deep  acting  caustics,  and 
even   the  X-ray  and  radium,   which  like 


NATURE  OF  CANCER  27 

surgery,  only  remove  the  focus  of  possible 
systemic  infection,  and  do  not  affect  the 
basic  cause  of  the  complaint :  this  latter  is 
being  shown  more  and  more,  by  scientific 
investigation  and  observation,  to  be  asso- 
ciated with  metabolic  or  chemico-physio- 
logical  changes  in  the  system,  and  evidence 
is  accumulating  that  it  is  dependent  upon 
them. 

iVU  this  leads  thoughtful  persons  to 
inquire  if  there  is  not  some  deeper,  fun- 
damental cause  lying  back  of  the  trou- 
ble, which  should  be  reached  and  rectified 
by  medical  skill  and  acumen,  something  to 
do  with  the  life  or  diet  of  a  person  which 
renders  the  tissues  liable  to  take  on  malig- 
nant disease.  So  that  a  recent  surgical 
writer  on  cancer  states  that  ''all  study, 
whether  clinical,  pathological,  or  experi- 
mental, points  to  the  fact  that  there  is 
some  underlying,  hidden  cause  which  leads 
to  that  aberration  in  the  action  of  tissue 
cells  which  we  call  cancer,"  ...  a  cause 


28   MEDICAL  ASPECTS  OF  CANCER 

*^  residing  in  only  the  cells  themselves  or 
in  some  abnormal  chemical  constitution  of 
the  plasma  bathing  the  cells,  or  in  both  of 
these  possibilities  acting  together. '^ 

Occupation  has  been  questioned,  but 
with  most  unsatisfactory  results,  for  in 
some  statistics  which  have  been  gathered 
cancer  has  been  observed  in  those  follow- 
ing all  possible  pursuits :  and  while  labor- 
ers stood  first  on  the  list,  clergymen  stood 
fourth,  while  carters,  threshers,  and 
guides,  who  would  be  exposed  to  local  in- 
jury, were  at  the  bottom  of  a  long  list.  It 
has  been  found,  however,  to  be  more  fre- 
quent in  trades  or  occupations  in  which 
the  individual  is  most  subject  to  the  ha- 
bitual abuse  of  alcoholics,  as  in  bartenders, 
printers,  etc. 

We  see,  then,  that  thus  far  no  satisfac- 
tory cause  has  been  established  for  the 
occurrence  of  cancer,  much  less  for  the 
steady  and  great  increase  of  the  disease  of 
late  years.     And  as  far  as  can  be  learned. 


NATURE  OF  CANCER  29 

no  measures  are  recognized,  or  at  least 
generally  adopted,  to  prevent  its  occur- 
rence or  recurrence;  although,  as  already- 
stated,  modem  surgery  has  seemed  to  im- 
prove the  statistics  in  regard  to  its  mor- 
tality in  certain  forms  or  locations,  and 
the  X-ray  and  radium  have  certainly  also 
been  able  to  remove,  perhaps  temporarily, 
some  of  the  products  of  the  disease. 

We  come  then  to  the  question,  what  is 
the  real  nature  of  cancer?  Alas,  all  scien- 
tific, experimental,  and  clinical  investiga- 
tions have  failed  to  solve  the  problem, 
except  that  all  '  *  evidence  points  to  the 
conclusion  that  cancer  is  to  be  considered 
as  a  pathological  disturbance  of  the  nor- 
mal cell  life, '  ^  from  some  unknown  cause. 
A  curious  suggestion  has  been  made  by 
Schmidt,  who  found  that  of  241  cases  of 
cancer  of  the  chylopoietic  system,  180  had 
never  had  any  infectious  disease  of  child- 
hood, and  99  went  through  life  without  any 
infection  of  any  kind;  the  figures  point  to 


30   MEDICAL  ASPECTS  OF  CANCER 

the  existence  of  a  cancer  diathesis — one 
which  is  resistent  to  germs. 

It  would  carry  us  too  far  from  the  prac- 
tical side  of  our  subject,  even  if  we  were 
at  all  able,  to  present  or  analyze  the  vast 
number  of  contributions  which  have  been 
made  to  the  pathological  histology  of  can- 
cer, and  the  changes  which  take  place  in 
the  transformation  of  normal  cells  into 
those  of  malignant  character:  the  amount 
of  microscopic  work  which  has  been  done 
along  this  line  can  hardly  be  imagined,  and 
the  literature  relating  to  it  is  enormous. 

Ewing,  accepting  the  definition  that  the 
cancer  process  is  *^  atypical  and  destructive 
proliferation  of  epithelium, ' '  quotes  Ribert 
as  saying  that  ^'no  one  has  ever  seen  the 
beginnings  of  mammary  cancer'':  but  he 
does  not  bring  us  much  nearer  to  the  solu- 
tion of  the  cancer  problem  than  we  were 
before.  Bainbridge  rejects  all  possibility 
of  a  blood  condition,  and  finds  the  only 
solution  of  it  in  the  early  removal  of  every- 


NATURE  OF  CANCER  31 

thing  which  is  thought  to  lead  to  cancer, 
even  the  simplest  benign  new  formations, 
but  Ewing  states  that  '4n  some  cases  car- 
cinoma has  developed  after  excision  of 
wholly  benigTi  fibro-adenoma^':  and  the 
immense  number  of  cases  of  recurrent  can- 
cer after  operations  shows  that  we  must 
look  further  than  surgery  if  we  wish  to 
stay  the  progress  of  this  formidable  dis- 
ease. 

It  would  be  useless  to  attempt  to  present 
the  many  theories  which  have  been  ad- 
vanced relating  to  cellular  metaplasia,  or 
even  to  detail  all  the  more  or  less  accepted 
views  in  regard  to  the  manner  in  which 
normal  cells  change  and  degenerate  into 
those  of  malignant  character :  but  some  of 
the  principal  facts  may  be  of  service  in 
understanding  somewhat  of  the  mode  of 
development  of  malignant  tissue  from  that 
which  has  been  normal. 

The  statement  of  Virchow,  ^^Omnis 
cellula  e  cellula,''  that  is,  ''where  a  cell 


32   MEDICAL  ASPECTS  OF  CANCER 

arises  there  a  cell  must  have  previously 
existed,  just  as  an  animal  can  spring  only 
from  an  animal  and  a  plant  from  a  plant," 
forms  the  basis  of  all  study  on  the  genesis 
of  cancer  and  all  tumor  formation;  karyo- 
kinesis,  or  indirect  nuclear  or  cell  division, 
is  at  the  bottom  of  all  growth,  both  normal 
and  malignant,  and  the  two  classes  of 
growth  differ  only  in  their  methods  and 
activity.  In  healthy  tissues  cell  prolifera- 
tion and  destruction  proceed  in  an  orderly 
manner,  forming  homologous  structures, 
as  when  the  hair  and  nails  are  constantly 
produced  from  newly  formed  cells  at  the 
root,  and  the  result  of  this  new  growth  is 
removed  mechanically  when  the  hair  and 
nails  are  cut  from  time  to  time,  or  the  hairs 
fall  out.  In  the  case  of  the  skin  the  epider- 
mal layers  are  pushed  forward  and  finally 
exfoliated  as  useless  epithelial  debris. 

With  the  cells  composing  other,  or  inter- 
nal structures,  however,  the  process  is  dif- 
ferent.   For  here  each  normal  cell  repro- 


NATURE  OF  CANCER  33 

duces  others  of  homologous  structure,  and 
the  different  parts  of  the  system  are  thus 
kept  in  active  service  through  anabolism, 
by  means  of  which  new  cells  are  formed 
with  renewed  vitality,  and  the  older,  or 
elf  ete  cells  are  removed  by  catabolism ;  the 
elements  of  which  they  are  composed  are 
thus  split  up  into  their  component  parts, 
and  carried  off  by  the  blood  or  lymph 
stream,  and  are  then  either  discharged  as 
effete  substances  or  reutilized  in  the  sys- 
tem, along  physiological  lines.  Wakefield 
has  pretty  clearly  shown  that  the  develop- 
ing cancer  cell  is  the  product  of  sub-cat- 
abolism,  or  a  sub-oxygenation,  induced  by 
hyperacidity  or  oxidase  deficiency  in  the 
surrounding  medium  of  the  blood  plasma. 
A  great  deal  of  thought,  study,  and  spec- 
ulation have  been  given  in  regard  to  the 
behavior  of  the  cells  themselves,  and 
strong  arguments  are  adduced  for  a  local 
cell  pathology,  that  is,  regarding  the  cells 
as  *' autonomous  beings,  possessed  of  mor- 


34   MEDICAL  ASPECTS  OF  CANCER 

pliological  and  physiological  independ- 
ence.'^  But  on  the  other  hand  we  must 
recognize  some  restraining  influence  which 
continually  causes  the  great  mass  of  cells 
to  reproduce  those  of  homologous  struc- 
ture, in  an  orderly  manner,  and  only  very 
rarely  some  of  them  to  break  loose  and 
form  tumors,  which  may  then  become  ma- 
lignant and  even  destroy  life.  How  this 
restraining  influence  is  modified  or  with- 
drawn is,  of  course,  a  part  of  the  problem 
of  cancer.  Those  who  maintain  their  au- 
togenous character  lay  great  stress  upon 
the  polarity  of  cells,  and  the  relation  of 
the  centrosome  to  the  nucleus,  indicating 
a  change  in  the  polar  axis  in  cells  about  to 
be  cancer-genetic,  as  does  Ewing  in  his  re- 
cent classical  study  of  pre-cancerous  le- 
sions. But  whatever  changes  are  observed 
microscopically  we  must  recognize  that  the 
cells  themselves  must  be  influenced  ulti- 
mately by  that  mysterious  force  which  we 
call  life,  which   ends  with  its   extinction 


NATURE  OP  CANCER  35 

from  the  body  as  a  whole,  and  which  is 
ultimately  related  to  nerve  action.  We 
must  also  recognize  that  the  cells  every- 
where depend  for  their  life  and  activity 
upon  the  plasma  in  which  they  are  bathed 
and  from  whence  they  draw  their  suste- 
nance ;  and  this  plasma  is  renewed  day  by 
day  from  the  food  and  drink  taken. 

Students  of  cancer  are  more  and  more 
recognizing  and  acknowledging  that  '^all 
these  phenomena,  apparently  so  different, 
are  merely  protean  manifestations  of  one 
common  process  which  underlies  and  is  the 
cause  of  them  all,  to  wit,  cell  growth  and 
proliferation.  The  particular  outcome  of 
the  process  in  any  given  case  is  due  to  the 
influence  of  the  conditions  of  nutrition — 
understanding  by  this  term  the  whole  of 
the  material  changes  wrought  in  the  organ- 
ism through  its  relation  with  the  surround- 
ing world.  This  being  so  it  is  easy  to 
understand  how,  under  favorable  condi- 
tions, certain  cells  may  take  on  independ- 


36   MEDICAL  ASPECTS  OF  CANCER 

ent  action,  growing  and  multiplying  with- 
out regard  to  the  requirements  of  adjacent 
tissues  and  of  the  organism  as  a  whole. '^ 

There  seems  to  be  some  reason  to  sup- 
port the  view  advocated  by  Williams,  that 
tumor  formation  and  growth  are  but  forms 
of  agamogenesis,  or  non-sexual  reproduc- 
tion of  cells,  distinctly  related  to  the  de- 
cline in  growth  of  the  body  in  general. 
Hence  while  the  forces  of  growth,  develop- 
ment, and  reproduction  are  in  greatest  ac- 
tivity the  tendency  to  this  disease  is  rela- 
tively small :  but  when  growth  declines  and 
nutrition  is  relatively  low  the  cells  undergo 
gemmation,  owing  to  perverted  nutriment, 
and  thus  hyperplasia  and  not  inflammation 
is  the  starting  point  of  every  neoplasm. 

Experimental  work  has  time  and  again 
demonstrated  that  cell  growth,  either  good 
or  bad,  is  modified  in  no  uncertain  way  by 
the  character  of  the  nutrition  furnished. 
Cancer  has  repeatedly  been  observed  to 
disappear  spontaneously,  as  such  cases  are 


NATURE  OF  CANCER  37 

on  record  by  careful  and  competent  medi- 
cal men:  in  certain  of  these  instances  it 
has  occurred  in  connection  with  a  radical 
change  in  the  mode  of  life  and  diet,  but  in 
the  majority  of  instances  there  is  no  record 
of  the  special  cause  of  its  disappearance. 
The  lesson  to  be  learned  from  this  is  that 
there  are  conditions  of  the  system  which 
are  antagonistic  to  the  abnormal  prolifer- 
ation of  cell  tissue,  even  when  it  has  begun 
to  take  place,  as  we  must  believe  that  there 
are  other  conditions  of  the  system  which 
favor  such  diseased  action  of  aberrant 
cells. 

An  interesting  confirmation  of  this  is  at- 
tributed to  Ehrlich,  but  I  cannot  find  the 
original  reference.  He  ^4ias  shown  that 
mice  living  upon  a  rice  diet  cannot  be  inoc- 
ulated with  cancer,  while  mice  living  on  a 
meat  diet  can  be  readily  inoculated,  can- 
cerous tumors  developing  quickly  and  con- 
tinuing to  grow  until  the  animal  dies. 
Ehrlich  also  found  that  when  mice  with 


38   MEDICAL  ASPECTS  OF  CANCER 

cancerous  tumors,  the  result  of  inoculation, 
were  placed  upon  a  rice  diet,  the  tumors 
ceased  to  grow,  and  in  many  cases  degener- 
ated and  disappeared.''  Valuable  cor- 
roboration of  this  has  been  given  by  Sweet, 
Corson,  White,  and  Saxon.  They  made  a 
series  of  experiments  in  regard  to  the  ^in- 
fluence of  certain  diets  upon  the  growth  of 
experimental  tumors,"  all  with  the  same 
results.  Of  fifty  white  mice,  25  fed  on 
glutenin  and  gliadin,  and  25  on  normal 
diet,  23  of  the  25  on  normal  diet  acquired 
tumors,  against  only  4  in  the  25  on  the  glu- 
tenin and  gliadin.  This  was  repeated  on 
50  males,  with  the  result  of  18  in  25  against 
3  in  25 :  and  in  a  third  series,  of  50  females, 
the  figures  were  15  in  25  against  7  in  25. 
Thus,  they  found  that  75  per  cent,  of  75 
mice  developed  experimentally  inoculated 
tumors  when  under  normal  diet,  while  only 
19  per  cent,  of  other  75  mice  developed 
such  tumors  when  under  a  diet  of  glutenin 
and  gliadin,  that  is,  vegetable  proteins; 


NATUEE  OF  CANCER  39 

moreover,  the  tumors  in  tlie  latter  were  in 
30  days  hardly  larger  than  those  in  the 
former  in  10  days.  Eous  has  recently 
shown  that  large  growths  of  certain  trans- 
IDlanted  rat  and  mouse  tumors  are  checked 
in  their  development  by  underfeeding  the 
host  on  a  special  diet. 

The  chemistry  of  cancer  has  been  studied 
in  most  varied  directions,  and  the  litera- 
ture relating  thereto  is  very  voluminous 
and  can  be  hardly  more  than  alluded  to 
here.  It  is  unfortunate,  however,  that  most 
of  the  researches  have  been  made  in  con- 
nection with  patients  who  have  advanced 
cancer,  and  very  commonly  with  the  dis- 
ease affecting  internal  organs,  which  of  it- 
self interferes  very  greatly  with  their 
function,  and  so  causes  many  of  the  per- 
turbations of  metabolism  observed.  What 
is  needed  are  researches  in  regard  to  the 
metabolism  of  patients  before  the  develop- 
ment of  the  disease,  or  in  its  earlier  stages, 
before  it  has  exerted  its  injurious  effects 


40   MEDICAL  ASPECTS  OF  CANCER 

on  the  system,  in  order  to  learn  of  the 
causes  which  lead  up  to  and  induce  the 
wrong  action  of  the  cellular  elements, 
whose  invasion  and  malignant  action  sub- 
sequently become  so  serious. 

It  is  quite  impossible  in  these  lectures  to 
enter  at  all  fully  upon  the  various  bio- 
chemical studies  which  have  been  carried 
on  in  regard  to  cancer,  but  brief  mention 
will  be  shortly  made  of  some  of  the  salient 
points.  Not  only  has  the  structure  of  car- 
cinomatous tissue  been  examined  chem- 
ically, but  the  blood  and  urine  have  been 
submitted  to  most  painstaking  investiga- 
tion, and  metabolism  in  general  has  been 
studied  in  almost  all  possible  directions,  in 
the  search  for  the  cause  of  cancer ;  and  yet, 
as  Beebe  says,  ''no  phase  of  metabolism 
has  been  described  in  cancer  which  does  not 
have  a  counterpart  in  non-cancerous  con- 
ditions." But,  as  previously  mentioned, 
all  these  observations  and  studies  have 
been  largely  made  upon  advanced  cancer 


NATURE  OF  CANCER  41 

cases,  when  the  system  has  already  felt  the 
unsettling  and  depressing  effect  of  what  is 
probably  an  injurious  secretion  from  the 
deranged  and  actively  proliferating  cells 
of  the  cancerous  mass.  In  a  later  lecture 
we  will  consider  some  of  these  matters  in 
so  far  as  they  have  relation  to  the  dietetic 
and  medical  treatment  of  cancer. 

The  essence  of  our  study  thus  far  has 
been,  that  in  every  instance  what  is  called 
malignant  disease  is  but  an  aberrant  action 
of  originally  normal  body  cells.  That,  as 
normal  cells  find  their  nutriment  in  the  cir- 
culating plasma,  so  some  pathological 
change  in  this  latter  causes  them  to  take 
on  abnormal  action,  and  they  no  longer  de- 
velop homologous  cells,  capable  of  forming 
normal  tissue,  but  heterologous  elements 
which  have  a  natural  tendency  to  disinte- 
grate or  break  down,  and  exert  a  destruc- 
tive influence  on  adjoining  cells  of  any 
kind;  and  in  this  process  they  secrete  a 
hormone  which  is  prejudicial  to  the  system 


42    MEDICAL  ASPECTS  OF  CANCER 

and  tends  to  destroy  life.  In  later  lectures 
we  shall  endeavor  to  understand  this  more 
perfectly,  and  consider  some  of  the  ele- 
ments in  life  which  tend  towards  the  pro- 
duction and  arrest  of  cancer. 


LECTURE  II 

FKEQUENCY   AND   GEOGRAPHICAL   DISTRIBUTION 
OF    CANCER 

Cancer  in  man  exists  all  over  tlie  globe, 
but  in  ditferent  degrees  of  frequency,  ac- 
cording to  varying  conditions  of  life,  as  we 
shall  presently  see.  Malignant  growths 
occur  also  in  animals  and  fishes,  though 
also  with  greatly  varying  frequency  under 
different  conditions ;  but  there  are  few  real 
tumors  in  reptiles  or  amphibians.  Tumors 
are  also  occasionally  found  in  vegetable  or- 
ganisms, presenting  increased  growth  and 
proliferation  of  cells,  arising  from  adven- 
titious, or  abnormally  evolving  buds,  as 
also  from  parasitic  and  other  external  irri- 
tants. While  these  vegetable  tumors  are 
very  interesting  and  in  a  measure  instruc- 

43 


44   MEDICAL  ASPECTS  OF  CANCER 

tive,  in  regard  to  tlie  peculiarities  of  cell 
growth  wliicli  they  exhibit,  they  bear,  of 
course,  no  relation  to  cancer  in  the  animal 
kingdom,  although  some  have  endeavored 
to  argue  otherwise.  There  is,  however,  a 
certain  suggestion  of  analogy  to  be  found 
in  the  observation  made  by  one  writer, 
that  *4he  origin  of  buds,  as  well  as  their 
subsequent  development,  is  chiefly  deter- 
mined by  the  conditions  of  nutrition. 
Wherever  there  is  an  excess  of  nutritive 
material,  capable  of  being  utilized  for 
growth  by  the  cells  of  the  part,  there  buds 
may  arise'*;  we  shall  see  later  that  the 
same  thought  applies  to  cancer  in  man  and 
animals,  when  we  come  to  the  consideration 
of  the  relation  of  overindulgence  along  cer- 
tain lines  of  eating  and  drinking  to  cancer. 
Cancer  has  well  been  styled  a  disease  of 
modern  civilization,  like  tuberculosis,  al- 
though of  quite  a  different  nature.  Inter- 
esting studies  have  been  made  in  regard  to 
the  increased  death  rate  from  the  former 


FREQUENCY  OF  CANCER        45 

in  England,  coincident  with  a  diminislied 
mortality  of  the  latter,  in  accordance  with 
nutritional  changes  which  have  taken  place 
in  certain  populations :  and  in  the  first  lec- 
ture I  mentioned  that  in  the  United  States 
the  mortality  from  tuberculosis  had  fallen 
25  per  cent,  between  1900  and  1912  while, 
as  we  shall  see  later,  the  mortality  from 
cancer  has  certainly  risen. 

Williams,  who  quotes  very  largely  from 
the  accurate  statistics  which  have  long 
been  carefully  recorded  in  England,  says 
that  ^^  while  tubercle  has  declined  with 
great  rapidity,  cancer  has  increased  at  a 
still  faster  rate,  and  these  inversely  related 
changes  are  still  in  active  progress.  In 
illustration  of  these  remarks  it  may  be 
mentioned  that  during  the  last  half  of  the 
nineteenth  century,  the  cancer  mortality 
for  England  tripled:  while,  during  the 
same  period  the  tubercle  death  rate  de- 
clined to  the  extent  of  nearly  one-half. 
Unless  some  great  change  in  the  national 


46   MEDICAL  ASPECTS  OF  CANCER 

habits  takes  place,  of  wliicli  there  is  at  the 
present  no  well  marked  indication,  cancer 
will  ere  long  claim  more  victims  than 
phthisis,  as  is  already  the  case  in  many 
localities — e.  g.,  Hampstead,  Clifton,  Bath, 
etc."  He  further  says,  ^'I  regard  this  de- 
cline in  the  presence  of  tuberculous  dis- 
eases as  the  direct  outcome  of  the  better 
food  and  improved  hygienic  conditions,  for 
which  we  are  indebted  to  our  increased  na- 
tional prosperity:  and  I  shall  endeavor  to 
show  that  conditions  of  this  kind,  by  their 
action  in  another  direction,  are  also  mainly 
responsible  for  the  augmented  cancer  mor- 
tality.'' We  shall  see  later  that  cancer  has 
asserted  itself  where  modern  civilization 
has  augmented  the  opportunities  of  over- 
indulgence along  many  lines  of  eating  and 
drinking:  for  while  advancing  scientific 
knowledge  has  undoubtedly  diminished 
mortality  in  general,  and  has  added  to  the 
average  length  of  life,  the  various  factors 
included  in  our  modern  mode  of  living  have 


FREQUENCY  OF  CANCER        47 

also  with  certainty  increased  morbidity 
along  such  lines  as  neurotic  and  vascular 
disorders,  tumors,  etc. 

All  statistics  from  various  localities 
show  that  cancer  has  certainly  increased 
in  frequency  very  greatly  of  late  years,  and 
though  some  have  attempted  to  claim  that 
this  increase  is  only  apparent,  and  is  due 
to  greater  accuracy  of  diagnosis,  and  the 
prolonging  of  more  lives  to  an  age  when 
cancer  is  more  common,  there  is  no  doubt 
in  the  minds  of  those  who  have  studied  the 
figures  that  the  increase  is  certainly  very 
real;  and  unless  there  be  found  some  way 
to  check  its  production,  the  death  rate  at 
the  end  of  the  century  will  be  appalling. 

It  is  quite  impossible  here  even  to  give 
a  comprehensive  idea  of  the  immense 
amount  of  work  which  has  been  given  to 
the  study  of  the  statistics  of  cancer  in  vari- 
ous parts  of  the  world,  as  collected  in  the 
remarkable  works  of  Roger  Williams  and 
Jacob  Wolff,  but  brief  mention  must  be 


48   MEDICAL  ASPECTS  OF  CANCER 

made  of  some  of  the  items  observed  and 
recorded  in  order  to  properly  understand 
our  subject.  Williams  in  particular  has 
analyzed  the  recorded  facts  in  an  interest- 
ing and  convincing  manner,  and  shown 
again  and  again  in  connection  with  the  fig- 
ures from  different  countries,  sections,  and 
cities,  that  the  occurrence  of  cancer  bears 
a  striking  relation  to  the  condition  of  the 
people  in  reference  to  their  material  pros- 
perity; namely,  that  the  well-to-do,  who 
can  overindulge  in  many  ways  are  vastly 
more  subject  to  cancer  than  those  in  the 
poorer  walks  of  life;  also  that  aborigines 
in  the  wilder  parts  of  the  world  are  either 
almost  exempt  from  cancer,  or  suffer  from 
it  to  a  very  much  less  degree  than  civilized 
foreigners  who  come  to  their  lands.  This 
is  also  shown  in  a  very  striking  manner  by 
Wolff,  and  I  present  here  a  table  which 
he  gives  in  regard  to  the  progress  of  can- 
cer in  a  single  country,  Australia,  among 
the  native  born  and  foreigners. 


FREQUENCY  OF  CANCER        49 


OF    100,000  LIVING   THERE   DIE   OF   CANCER    IN 
AUSTRALIA 


X limber  of 

yativG 

Eng- 

Other 

Year 

Inhahitants 

Born 

lish 

yationalities 

1851    ... 

.  . .       403,889 

28 

14 

1861    ... 

.  .  .    1,153,973 

5.6 

30.5 

19 

1871    ... 

...    1,168,377 

9.7 

56.7 

25 

1881    ... 

...    2,252,167 

16.8 

72.9 

32.6 

1891    ... 

...    3,183,237 

19.8 

119.8 

45.9 

1901    ... 

,  ..    3,771,715 

22.6 

203.1 

57.3 

He  remarks,  ''We  see  from  this  compari- 
son in  what  a  great  degree  the  death  rate 
from  cancer  has  increased  in  foreigners  as 
compared  to  the  native  born,  in  whom  the 
disease  has  remained  about  stationary, 
when  the  increase  in  population  is  consid- 
ered. ' '  Another  writer  remarks  that  when 
native  Australians  mingle  with  foreigners 
as  servants  or  employes,  and  adopt  their 
diet  and  customs,  cancer  occurs  more  fre- 
quently in  them.  Much  the  same  has  been 
reported  in  regard  to  other  peoples  and 
nationalities,  and  later  we  will  consider  the 
influences  of  urban  life  on  the  production 
of  cancer. 


50   MEDICAL  ASPECTS  OF  CANCER 

In  New  Zealand,  according  to  Hislop  and 
Fenwick,  where  the  general  death  rate  is 
the  lowest  in  the  world,  cancer  is  on  the 
increase,  as  civilization  advances.  In  the 
great  majority  of  cases  the  alimentary 
canal  is  the  seat  of  invasion,  even  in 
women:  all  the  patients  studied  were 
hearty  eaters,  taking  also  very  much 
strong  tea  many  times  daily. 

The  Polynesians  and  Melanesians  seem 
to  be  peculiarly  exempt  from  cancer.  Sir 
William  McGregor,  although  he  had  oper- 
ated several  times  on  whites  in  the  Fiji 
Islands,  never  remembers  operating  on  a 
Polynesian  or  Melanesian,  who  are  prac- 
tically vegetarians.  He  never  saw  a  case 
in  British  Guinea  in  9%  years,  and  then 
saw  an  encephaloid  cancer  of  the  tibia  in 
a  Papuan,  who  for  7  or  8  years  had  lived 
practically  a  European  life,  eating  canned 
Australian  meat  daily. 

In  regard  to  Africa,  Williams  quotes 
Dr.  Madden  of  Cairo,  who  says,  ^  ^  The  con- 


FREQUENCY  OF  CANCER        51 

sensus  of  opinion  among  medical  men  in 
Egypt  is,  that  cancer  is  never  found,  either 
in  male  or  female,  among  the  black  races 
of  that  comitry.  These  include  the  Ber- 
berines  and  the  Sudanese,  who  are  all  Mus- 
sulmans, and  live  almost  entirely  upon 
vegetable  diet."  Of  19,529  deaths  among 
natives  of  Cairo  during  1891,  only  19  were 
due  to  cancer  (females  10,  males  9)  or  1 
in  1028.  In  England  during  the  same  year 
the  proportion  of  cancer  deaths  to  total 
deaths  was  1  in  29.  In  the  Islands  of 
LagOo,  on  the  West  Coast  of  Africa,  Dr. 
Johnson,  in  14  years'  practice  there  saw  5 
^ases  of  cancer  in  natives  all  of  whom 
lived  as  Europeans.  In  southern  Africa, 
*' among  the  Boers  and  Europeans,  who 
are  large  flesh  eaters,  malignant  tumors  are 
common:  but  among  the  natives,  who  are 
mainly  vegetarians,  these  tumors  are  so 
rare  as  to  be  almost  unknown." 

Renner  reports  interestingly  in  regard 
to  cancer  among  the  descendants  of  liber- 


52   MEDICAL  ASPECTS  OF  CANCER 

ated  Africans  or  Creoles,  in  Sierra  Leone, 
Africa.  During  30  years,  from  1870  to 
1900,  there  were  but  20  cases  recorded  as 
malignant  disease  among  22,453  admitted 
to  the  Colonial  Hospital:  in  the  next  ten 
years  there  were  26  among  a  total  of  10,163, 
a  slow  but  steady  gain  in  cancer  incidence, 
with  the  advancing  influence  of  the  white 
man.  He  says  that  while  the  aborigines 
eat  no  meat,  the  ^^ Creoles"  eat  much  meat; 
the  teeth  of  the  latter  are  beginning  to 
decay,  like  those  of  the  whites,  which  is  at- 
tributed to  the  sweets  introduced  by  the 
latter.  Every  case  of  cancer  recorded  has 
been  in  a  Creole,  living  like  a  European, 
and  not  a  single  case  among  the  aborigines. 
Much  the  same  freedom  from  cancer  has 
been  noted  in  regard  to  negroes  when  first 
brought  to  the  United  States  in  slavery, 
when  their  food  and  mode  of  life  was  sim- 
ple :  but  since  emancipation  and  in  propor- 
tion as  they  have  mingled  with  whites  and 
eaten  their  food,  with  their  own  natural 


FREQUENCY  OF  CANCER        53 

tendency  to  gluttony  and  laziness,  cancer 
has  increased  among  them,  although  their 
death  rate  from  malignant  disease  is  still 
much  less  than  that  of  Tvhites. 

In  India  all  writers  agree  that  cancer  is 
rare  among  the  inhabitants  of  warmer 
country  districts,  where  they  live  largely 
on  rice  or  millet,  with  a  little  milk  and  but- 
ter, and  vegetables:  they  eat  meat  rarely, 
the  immense  majority  of  the  people  live  a 
rural  life,  depending  upon  agriculture  for 
their  sustenance. 

Investigations  of  late  years,  however, 
might  seem  to  indicate  that  cancer  is  more 
prevalent  in  India  than  previously  sup- 
jDOsed,  but  its  incidence  still  bears  no  real 
relation  to  that  in  many  other  countries, 
and  an  analysis  of  some  recent  reports  ex- 
plains in  an  interesting  and  curious  man- 
ner the  reasons  for  the  diversity  of  opinion 
as  to  the  actual  frequency  of  the  disease. 

Thus,  Benratt  collected  a  total  of  1700 
cases  onlv  from  5  vears'  statistics  of  15 


54   MEDICAL  ASPECTS  OF  CANCER 

Mission  Hospitals  and  34  Government  Hos- 
pitals, representing,  of  course,  many  mil- 
lion inhabitants,  whereas  in  New  York 
City,  according  to  the  weekly  Bulletin  of 
the  Board  of  Health,  there  were  2193 
deaths  from  cancer  in  the  last  six  months, 
a  striking  illustration  of  the  rarity  of  can- 
cer in  India.  Moreover  of  these  1700 
cases,  over  1200  were  about  the  mouth,  a 
very  large  share  of  these  arising  from  the 
very  common  habit  of  chewing  betel,  which 
contains  also  much  calcium,  which  latter  is 
one  of  the  salts  incriminated  in  the  causa- 
tion of  cancer.  Sandwith  attempts  to 
show  that  cancer  is  prevalent  in  India,  but 
refers  to  only  2000  cases  reported  in  the 
hospitals  there,  in  three  years,  also  among 
many  millions  of  people,  and  he  refers  like- 
wise to  the  betel  chewing  cancer,  and  the 
^^kangri  burn"  on  the  abdomen  of  men, 
from  the  charcoal  furnace  worn  for 
warmth :  these  peculiar  local  disorders  viti- 


FREQUENCY  OF  CANCER        55 

ate  any  deductions  wliicli  could  be  drawn 
from  such  statistics. 

In  China,  according  to  a  recent  writer, 
^'cancer  is  comparatively  uncommon  in 
those  parts  where  the  bulk  of  the  people 
live  on  an  almost  exclusively  vegetarian 
diet,  being  too  poor  to  purchase  any  of  the 
various  flesh  foods,  which  are  there  used 
for  culinary  purposes.  But  in  places 
where  cancer  is  said  to  be  more  prevalent, 
the  reporter  adds,  ^^AU  Chinamen  there  eat 
fish  and  pork  at  morning  and  evening 
meals :  fowls  and  ducks  are  always  on  the 
table  of  all  but  the  most  humble  of  the 
coolie  class.'' 

In  regard  to  the  occurrence  of  cancer  in 
the  Far  East,  however,  some  of  the  modern 
investigators,  such  as  Bashford,  have  en- 
deavored to  overturn  the  generally  ac- 
cepted view  as  to  its  infrequency,  but  I  do 
not  feel  that  the  evidence  presented  can  at 
all  weigh  against  the  unprejudiced  opinion 


56   MEDICAL  ASPECTS  OF  CANCEK 

of  most  capable  medical  men  who  have  long 
lived  and  practiced  in  those  regions,  some 
of  whom  as  medical  missionaries  have  had 
most  intimate  contact  and  acquaintance 
with  the  natives.  Only  very  recently  a 
medical  missionary,  who  has  long  been  con- 
nected with  the  medical  college  and  hos- 
pital in  Beirut,  Syria,  told  me  that  cancer 
was  practically  unknown  among  the  thou- 
sands of  patients  who  flock  there  from  all 
over  the  Near  East,  he  adding  that  they 
were  all  largely  vegetarians. 

During  a  rather  extensive  trip  through 
the  Far  East  I  was  unable  to  see  or  even 
hear  of  any  cancer,  although  I  met  a  large 
number  of  medical  men,  and  made  diligent 
inquiry  regarding  the  same.  As  I  wished 
to  verify  my  views  in  regard  to  the  rarity 
of  the  occurrence  of  cancer  among  those 
who  lived  on  rice  or  other  vegetarian  diet, 
I  visited  very  many  civil,  military,  and 
mission  hospitals,  with  a  total  of  many 
thousands  of  patients,  and  ministering  to 


FREQUENCY  OF  CANCER       57 

many  millions  of  population;  in  Japan, 
Korea,  China,  the  Philippines,  India,  Siam, 
and  Egj^pt,  I  met  the  same  response,  that 
cancer  was  rarely  seen  among  those  vege- 
tarian natives. 

Brazil  is  credited  with  having  the  lowest 
cancer  record  of  any  portion  of  the  west- 
ern hemisphere,  especially  among  the  na- 
tives in  the  Equatorial  regions,  while  in 
the  Argentine  Republic,  where  meat  is 
known  to  be  largely  consumed,  cancer  is 
fairly  common.  From  many  parts  of  the 
world  there  come  reports  of  the  relative 
infrequency  or  even  absence  of  cancer 
among  simple  living  natives,  one  writer  in 
regard  to  the  West  Indies  stating  ''Even 
those  cases  which  I  have  witnessed  in  this 
class  of  people  have  been  among  the  better 
orders  of  them,  whose  habits  of  living  as- 
similated to  those  of  Europeans.^' 

England  and  Wales  present  the  most 
satisfactory  field  for  the  study  of  the  prog- 
ress of  cancer,  as  the  national  vital  statis- 


58   MEDICAL  ASPECTS  OF  CANCER 

tics  have  been  well  kept  since  1840 ;  even  at 
that  time  under  the  able  direction  of  Wil- 
liam Farr  they  had  already  acquired  a  well- 
deserved  reputation  for  reliability,  as  Wil- 
liams remarks,  from  whom  I  shall  freely 
quote. 

In  that  year,  1840,  there  died  of  malig- 
nant disease  in  England  and  Wales  1  in 
5,646  of  the  total  population,  1  in  129  of 
the  total  mortality,  or  117  per  million  liv- 
ing. In  1905,  the  deaths,  due  to  this  cause 
were  1  in  1,131  of  the  total  population,  1 
in  17  of  the  total  mortality,  or  885  per  mil- 
lion living :  thus,  while  the  population  had 
only  a  little  more  than  doubled,  the  cancer 
death  rate  per  million  living  had  increased 
^Ye  fold.  Dr.  Williams  answers  by  figures 
and  tables  the  several  objections  which 
have  been  raised  in  regard  to  the  actual  in- 
creased mortality  from  cancer,  as  it  has 
been  repeatedly  claimed  that  the  increase 
is  only  apparent  and  not  real;  thus  it  has 
been  asserted  that  it  is  due — 1.  To  mere 


FREQUENCY  OF  CANCER        59 

increase  of  population:  2.  To  the  average 
age  of  the  jDopulation  having  advanced: 
and  3.  To  improved  diagnosis  and  more 
carefnl  death  certification.  Time  does  not 
admit  a  full  presentation  of  his  statistical 
refutation  of  these  claims,  to  which  he  de- 
votes some  pages  very  convincingly,  but  it 
can  be  safely  accepted  that  for  some  as  yet 
unknown  reason,  cancer  has  made  strides 
in  England  which  are  truly  alarming. 

Williams  has  also  made  some  most  inter- 
esting studies  in  regard  to  the  increase  of 
cancer  in  connection  with  changed  condi- 
tions of  life,  and  from  his  analysis  of  sta- 
tistics, he  very  clearly  shows  that  the 
spread  of  the  disease  has  closely  followed 
urbanization,  and  the  rapid  increase  in  ma- 
terial prosperit}^  of  recent  years:  in  Eng- 
land where  80  per  cent,  of  the  population 
are  now  town  dwellers,  this  tendency  to 
collect  in  cities  and  towns  has  gone  farther 
than  in  any  other  community.  He  recog- 
nizes that  any  far-reaching,  environmental 


60   MEDICAL  ASPECTS  OF  CANCER 

change  of  some  duration  is  probably  potent 
in  disturbing  the  stability  of  the  constitu- 
ents of  living  bodies,  and  the  sudden  change 
from  poverty  to  riches  and  plenty  is  con- 
ducive to  the  development  of  cancer :  allu- 
sion has  already  been  made  to  the  inverse 
relation  of  deaths  from  cancer  and  tubercu- 
losis, the  latter  diminishing  with  improved 
material  conditions,  while  the  former  in- 
creases as  wealth  and  indolence  increase. 
He  shows  this  by  statistics  from  various 
localities,  and  by  data  from  towns  in  ditf er- 
ent  countries  he  makes  it  pretty  clear  that 
'^Cancer  mortality  is  lowest  where  the  con- 
ditions of  life  are  hardest,  the  surroundings 
the  most  squalid,  the  density  of  population 
greatest,  where  the  tubercle  mortality  is 
highest,  the  general  and  infantile  mortality 
greatest,  and  where  sanitation  is  least  per- 
fect— in  short,  among  the  poor  of  the  indus- 
trial class  in  our  great  towns:  whereas 
among  the  wealthy  and  well-to-do,  where 
the  standard  of  health  is  at  its  best  and  life 


FREQUENCY  OF  CANCER        61 

is  easiest,  and  where  all  the  conditions  of 
life  are  just  the  reverse  of  the  foregoing, 
there    the    cancer   mortality   is   highest." 
"While  this  is  a  pretty  strong  statement 
and  many  exceptions  could  undoubtedly  be 
found,  careful  investigation  will  show  it  to 
be  true  in  the  main;  for  it  must  be  remem- 
bered that  even  among  the  poorer  classes 
gluttony,  especially  in  regard  to  proteids, 
is  not  at  all  uncommon,  and  indolence,  with 
impeded  metabolism,  is  not  at  all  unusual. 
Dr.  Latham  found  that  the  mortality  from 
cancer  in  England,  from  1881-1890,  was 
more  than  twice  as  great  among  well-to-do 
men    having    no    specific    occupation,    as 
among  occupied  males  in  general,  the  re- 
spective mortality  ratios  being  96  for  the 
former  and  only  44  for  the  latter.     Sir  Wil- 
liam Banks  confirms  the  steady  increase  in 
cancer  very  strongly,  which  he  attributes  to 
richer  and  more  abundant  food,  of  which 
males  eat  more  than  females,  and  conse- 
quently cancer  is  increasing  proportion- 


62    MEDICAL  ASPECTS  OF  CANCER 

ately  more  among  men,  as  all  statistics 
show. 

Switzerland  is  reported  to  have  the  high- 
est death  rate  from  cancer  of  any  country, 
it  having  augmented  from  114  per  100,000 
living  in  1889,  to  132  in  1898.  There  again 
the  cancer  mortality  varies  greatly  in  the 
different  sections  or  cantons :  thus,  in 
wealthy  Lucerne  it  is  204  per  100,000  liv- 
ing, and  only  36  in  poverty  stricken  Valais. 
In  the  city  of  Geneva  it  is  177  per  100,000 
living. 

Denmark,  next  to  Switzerland,  is  reputed 
to  have  the  highest  cancer  death  rate  of  any 
country  in  Europe,  viz.;  130  per  100,000 
living  in  1900.  But  here  the  statistics  are 
only  from  the  towns,  which  comprise  but  a 
quarter  of  the  whole  population:  the  per 
capita  wealth  is  said  to  be  higher  there 
than  any  other  country  in  Europe  except 
France. 

France  shows  a  high  cancer  mortality, 
with  a  constantly  increasing  death  rate; 


FREQUENCY  OF  CANCER        63 

and,  next  to  England,  France  is  the  richest 
country  in  Europe,  and  T^ealth  is  much 
more  widely  diffused :  the  French  workers 
own  nearly  8  times,  per  capita,  more  than 
those  in  England.  In  Paris  the  cancer 
death  rate  has  increased  as  follows,  for 
each  100,000  living,  in  1865,  84;  in  1870, 
91;  in  1880,  94;  in  1890,  108;  in  1900,  120. 

Italy,  a  comparatively  poor  country, 
shows  a  low  cancer  mortality,  hut  even 
here  it  is  increasing  from  20  per  100,000 
Hving  in  1880,  to  52  in  1899,  and  58  in  1905. 
The  consumption  of  meat  is  there  the  small- 
est in  any  European  nation,  namely  23 
pounds  per  capita  in  1895.  In  the  chief 
towns  the  rate  of  death  from  cancer  is 
high :  thus  for  each  100,000  living,  in  Flor- 
ence 137,  Ravenna  120,  Venice  103,  Milan 
101,  and  Rome  77. 

Time  does  not  permit  a  wider  survey  of 
the  field  of  distribution  of  cancer,  as  pre- 
sented so  remarkably  from  official  sta- 
tistics by  Williams,  and  Wolff ;  but  in  con- 


64  MEDICAL  ASPECTS  OF  CANCER 

nection  with  the  high  percentages  of 
deaths  above  quoted  among  the  richer 
classes  it  may  be  interesting  to  mention 
some  of  the  lowest  records.  Thus,  in  the 
poor  country  of  Kerry,  Ireland,  it  was  27 
per  100,000  living,  in  the  province  of  Dal- 
maltia  19,  in  the  Shetland  Islands  16,  in 
Servia  8  (from  1895  to  1904),  and  in  Cey- 
lon in  1903  the  mortality  from  cancer  was 
about  6  for  each  100,000  living. 

The  United  States,  unfortunately,  has 
not  kept  the  vital  statistics  of  the  country 
in  years  past  with  anything  like  the  full- 
ness and  accuracy  which  has  obtained  in 
England,  nor  even  at  the  present  time  is  it 
possible  to  learn  definitely  the  frequency 
and  increase  of  cancer  in  every  locality. 
But  all  the  statistics  which  have  been  gath- 
ered show  unequivocally  that  the  disease 
has  steadily  increased  in  a  manner  which 
is  alarming.  Analyzing  the  recorded 
deaths  from  cancer  in  thirty-one  cities,  and 
the  percentage  of  increase  in  four  years. 


FREQUENCY  OF  CANCER        65 

one  ^^n'iter  estimates  that,  if  the  same  in- 
crease is  continued,  bv  the  end  of  the 
century  there  will  be  a  death  rate,  approxi- 
mately, of  1000  in  every  100,000  inhabi- 
tants, or  one  in  every  hundred. 

In  a  recent  Bulletin  of  the  Board  of 
Health  of  New  York  City  the  following 
statements  are  made  in  regard  to  the  mor- 
tality from  cancer  in  1913:  ^^The  statis- 
tics of  our  seven  largest  cities  recently  tab- 
ulated, show  that  the  cancer  death  rate  was 
the  highest  on  record.  For  New  York 
City  the  rate  was  82  per  100,000  of  the 
population,  against  an  average  of  79,  for 
the  last  five  years :  for  Boston  118  against 
an  average  of  110 :  for  Pittsburg  79,  against 
an  average  of  70:  for  Baltimore  105, 
against  an  average  of  94:  for  Chicago  86, 
against  an  average  of  81 :  for  Philadelphia 
95,  against  an  average  of  88 :  for  St.  Louis 
95,  against  an  average  of  85. ' '  This  aver- 
age increase  of  almost  8  per  cent,  of  deaths 
from  cancer  in  the  combined  population  of 


66   MEDICAL  ASPECTS  OF  CANCER 

tliese  seven  cities,  during  the  last  five  years 
is  certainly  an  alarming  fact,  and  cannot 
be  explained  on  the  ground  of  greater  ac- 
curacy of  diagnosis :  for  it  is  not  to  be  pre- 
sumed that  there  has  been  such  great  im- 
provement along  diagnostic  lines  during 
the  single  year  1913. 

It  is  difficult  to  state  the  exact  preva- 
lence of  cancer  in  the  entire  United  States, 
as  the  ^'registration  areas"  include  only 
about  two-thirds  of  the  total  population: 
much  can  be  learned,  however,  from  the 
annual  volumes  published  since  1900.  Ac- 
cording to  these  Mortality  Statistics  of  the 
United  States,  the  deaths  from  cancer  and 
other  malignant  tumors  per  100,000  popu- 
lation were  as  follows :  in  1900,  63,  in  1904, 
70.2,  in  1909,  73.8 ;  and  in  1912  there  were 
46,531  deaths  from  cancer,  or  77  per 
100,000  population,  an  increase  in  the  death 
rate  from  this  disease  of  almost  25  per 
cent,  since  1900 ;  while,  as  before  stated  the 


FREQUENCY  OF  CANCER        67 

tuberculosis  mortality  had  fallen  a  little 
over  25  per  cent,  in  the  same  period. 

As  in  other  countries,  which  might  also 
be  expected  from  the  statements  already 
made,  the  disease  varies  in  frequency 
in  different  localities  and  communities. 
Thus,  cancer  is  stated  to  be  much  more 
prevalent  in  the  northern  than  in  the  south- 
ern states,  and  as  already  stated,  the  ne- 
groes are  much  less  subject  to  the  disease 
than  whites,  especially  when  they  are  living 
their  own  natural  home  life ;  but  when  they 
come  to  the  cities,  as  waiters,  etc.,  in  hotels, 
their  cancer  death  rate  increases.  But 
even  in  New  York  City  in  1912  the  deaths 
from  cancer  in  negroes  was  1  in  32.2  total 
deaths,  against  1  in  17.7  in  whites;  the 
mass  of  negroes  here,  of  course,  live  plainly 
and  work  hard.  The  North  American  In- 
dians also  are  believed  to  be  almost  exempt 
from  cancer  in  their  primitive  savage  con- 
dition, but  as  they  have  come  under  the 


6S   MEDICAL  ASPECTS  OF  CANCER 

influence  of  civilization  tliey  are  more  af- 
fected. It  has  also  been  noted  by  several 
observers  that  immigrants  and  their  de- 
scendants present  a  very  much  higher  mor- 
tality from  malignant  diseases  than  pre- 
vails in  their  native  countries ;  from  these 
and  other  considerations  Williams  sug- 
gests that  abrupt  change  of  environment 
may  also  be  a  factor  in  the  causation  of 
this  disease. 

We  have  thus  seen  while  cancer  is  very 
widely  distributed  over  the  globe  it  is  pres- 
ent in  varying  degrees  of  severity  in  dif- 
ferent localities,  and  careful  analysis  shows 
that  the  disease  atfects  different  classes  of 
persons  with  unlike  severity.  All  these 
statistical  studies  and  observations  serve 
to  confirm  the  statement  made  earlier  that 
cancer  is  a  disease  of  so-called  civilization, 
and  that  it  has  increased  in  proportion  as 
human  beings  have  come  under  the  influ- 
ence of  wealth,  and  consequent  luxury  and 
overindulgence,  with  bodily  inactivity;  all 


FREQUENCY  OF  CANCER        69 

these  elements  lead  to  a  disturbed  metabo- 
lism, which  as  we  shall  see  later,  is,  at  least, 
a  contributing  cause  to  the  deviation  from 
normal  of  some  of  the  cellular  elements  of 
the  body.  It  also  appears  that  some  of 
these  metabolic  shortcomings  have  to  do 
with  a  disturbed  nitrogenous  balance, 
which  is  due  to  the  constantly  increased 
consumption  of  meat.  In  1909  the  meat 
consumption  in  the  United  States  had 
reached  the  high  figure  of  172  pounds  per 
capita,  as  I  learned  recently  from  Wash- 
ington, a  far  greater  amount  than  in  Eng- 
land, 130  pounds,  as  already  stated;  and 
with  this  steady  increase  in  the  use  of 
nitrogenous  food  cancer  has  also  increased 
by  leaps  and  bounds  in  both  countries. 


LECTUEE  III 

METABOLISM    OF    CANCER 

In  the  first  lecture  we  saw  that  cancer  was 
an  alteration  of  the  normal  cells  of  the 
body,  whereby  they  take  on  a  malignant 
action  and  continue  to  do  so,  destroying 
contiguous  tissues  and  leading  to  a  lowered 
vitality,  with  an  apparent  poisoning  of  the 
system,  which  finally  causes  death.  As  the 
cells  of  various  organs  furnish  different 
secretions,  which  in  health  contribute  to 
proper  metabolism,  resulting  in  growth  or 
maintenance  of  the  tissues,  so  these  disor- 
dered cells  are  believed  to  secrete  a  toxic 
substance,  or  malignant  hormone,  which 
has  a  prejudicial  action  on  the  body,  and 
haBmolytic  action  on  the  blood,  as  has  been 
brought  out  pretty  clearly  by  Troisier  and 
others. 

70 


METABOLISM  OF  CANCER       71 

We  saw  that  as  yet  the  definite  cause  had 
not  been  determined,  why  at  some  period 
certain  cells  take  on  the  action  which  we 
call  cancer,  nor  why  they  persist  in  their 
destructive  course.  Long  continued  and 
abundant  laboratory  and  clinical  research 
have  about  decided  certain  questions  nega- 
tively in  regard  to  its  etiology,  so  that  in  a 
n>easure  the  field  is  cleared  for  the  study 
of  some  of  the  possible  basic  causes  of  the 
disease  in  question.  Thus,  all  are  pretty 
well  agTeed  that  cancer  is  not  contagious 
or  infectious,  that  it  is  not  caused  by  a 
micro-organism  or  parasite,  that  it  is  not 
wholly  due  to  local  injury,  that  it  does  not 
appertain  to  any  particular  occupation, 
that  it  is  not  hereditary  to  any  great  de- 
gree, that  it  does  not  especially  belong  to 
or  affect  any  particular  sex,  race  o»r  class 
of  persons,  nor  is  it  confined  to  any  loca- 
tion or  section  of  the  earth,  and  that  it  is 
not  wholly  a  disease  of  older  age. 

We  saw  further  that  there  appeared  to 


72   MEDICAL  ASPECTS  OF  CANCER 

be  good  evidence  that  certain  misplaced 
*^  embryonal  rests''  were  the  original 
starting  points  of  diseased  cell  action,  but 
as  these  are  now  known  to  exist  in  every 
one  from  birth,  this  otfers  no  real  explana- 
tion of  the  occurrence  of  the  disease  at 
different  times  in  life.  It  is,  of  course, 
quite  possible  that  local  injury  of  one  kind 
or  another  may  be  the  exciting  cause  which 
determines  that  a  cell  or  group  of  cells  shall 
revert  to  its  original  reproductive  activity, 
as  Williams  contends  that  the  process  is 
one  of  agamogenesis,  dependent  upon  ex- 
cessive and  faulty  nutrition.  The  question 
as  to  the  relation  of  uricacidsemia,  or 
lithaemia,  to  cancer  has  never  been  fully 
studied,  and  it  is  worth  considering 
whether,  as  in  gout  and  rheumatism,  to 
which  cancer  is  often  associated  and  per- 
haps closely  allied,  the  exciting  cause  may 
not  be  the  lodgment  somewhere  of  uratic 
deposit,  which  is  further  excited  and  fed 


METABOLISM  OF  CANCEE       73 

by  effete  or  imperfectly  oxidized  nitro- 
genous elements ;  for  later  we  shall  see  that 
perverted  metabolism,  largely  of  proteid 
elements,  is  closely  associated  with  cancer. 
AVe  noted  also  that  some  attributed  can- 
cer to  independent  cell  action,  relating  to 
the  polarity  of  cells,  etc.;  but  it  is  incon- 
ceivable that  a  cell  or  cells  can  idiopathic- 
ally  start  out  on  a  rampant  course  and 
pursue  it  with  increasing  severity,  even 
until  death  results,  without,  at  least,  some 
definite  pre-disposing  cause,  even  though 
diligent  and  earnest  work  has  not  as  yet  de- 
termined just  what  that  cause  may  be. 
The  error  has  been,  we  believe,  in  search- 
ing too  exclusively  by  the  microscope  and 
by  certain  laboratory  methods,  and  not 
sufficiently  along  clinical  and  bio-chemical 
lines.  For  it  must  be  recognized  that  all 
the  cells  of  the  body  are  continually  bathed 
in  the  vitalizing  fluid  of  the  blood,  whence 
they    derive    their    nutriment,    and    into 


74   MEDICAL  ASPECTS  OF  CANCER 

which,  with  the  lymphatics,  they  return  the 
products  of  their  vital  action,  by  anabolism 
and  catabolism. 

By  exclusion,  therefore,  we  are  reduced 
to  seek  the  etiology  of  cancer  along  other 
lines,  and  about  all  that  is  left  is  metabo- 
lism, as  influenced  by  advancing,  so-called 
civilization,  which  relates  very  largely  to 
diet  and  mode  of  life.  This  we  will  take 
up  later,  but  will  first  examine  some  of  the 
scientific  findings  in  regard  to  the  blood  in 
cancer,  and  data  relating  to  the  various 
secretions  and  excretions  of  the  body  bear- 
ing upon  metabolism  in  this  disease. 

That  the  blood  shows  great  changes  in 
advanced  cancer  is  recognized  by  all,  as  is 
clinically  manifested  by  the  intense  cach- 
exia and  anaemia  commonly  present  and 
always  strongly  marked  toward  the  end,  of 
which  the  cytology  has  been  very  fully 
studied  and  presented  by  Turk.  When 
then  examined  there  is  found  to  be  a 
marked  reduction  of  red  cells,  low  hsemo- 


METABOLISM  OF  CANCER       75 

globin    index,    and    distinct    leucocytosis, 
with  greatly  diminished  alkalescence. 

The  reported  changes  in  the  blood  have 
also  varied  with  the  location  of  the  malig- 
nant disease,  according  as  it  may  interfere 
mechanically  or  otherwise  with  the  func- 
tion of  certain  organs,  which  fact  naturally 
obscures  the  question  of  the  true  relation- 
ship of  the  blood  to  cancer.  Thus,  it  is 
stated  that  in  cancer  of  the  liver  and  pan- 
creas there  is  always  leucocytosis  and  gly- 
cogen, and  that  ^*  cancer  appears  to  inter- 
fere greatly  with  the  function  of  the  liver 
as  a  destroyer  of  intestinal  toxins,  they 
pass  into  the  general  circulation,  probably 
cause  the  glycogen  reaction,  and  at  least 
part  of  the  leucocytosis,  and  very  often 
give  rise  to  fever.''  There  are  also  other 
microscopical  alterations  in  the  blood  in 
late  cancer.  Thus,  degenerative  change  in 
the  leucocytes  are  common,  with  derange- 
ment in  the  normal  proportion  of  their  dif- 
ferent forms,  as  also  changes  in  the  ery- 


76   MEDICAL  ASPECTS  OF  CANCER 

throcytes,  with  nucleated  red  cells  and 
megalocytes  in  severest  cases. 

Price  Jones  in  a  study  of  the  blood  in  30 
cases  of  cancer  (9  of  the  breast)  found  the 
red  blood  cells  diminished  on  an  average  of 
6  per  cent.,  the  white  blood  cells  increased 
38  per  cent.,  lymphcocytes  increased  by  10 
per  cent.,  large  mononuclear  cells  increased 
164  per  cent,  and  polynuclears  42  per  cent. 
Bumham  states  that  in  the  severe  grades 
of  anaemia  with  malignant  disease,  poikilo- 
cytosis  is  marked,  and  nucleated  cells  of 
both  normoblastic  and  megaloblastic  type 
may  be  present.  The  red  corpuscles  may 
be  reduced  to  2,500,000,  and  exceptionally 
to  1,000,000.  Cohnreich  in  a  very  tech- 
nical study  of  blood  from  cancer  subjects, 
observed  very  great  increase  in  the  resist- 
ing power  of  the  red  blood  cells  to  osmotic 
tension,  that  is,  in  regard  to  their  haemo- 
globin, which  he  believed  to  be  of  diagnos- 
tic value  in  doubtful  cases. 

Unfortunately,  there  have  been  relatively 


METABOLISM  OF  CANCER      77 

few  studies  of  the  plasma  of  the  blood  in 
this  or  other  diseases;  and  yet  the  condi- 
tion of  this  fluid  must  be  of  the  utmost 
importance,  as  from  it  are  derived  the  nu- 
trient principles  not  only  of  the  solid  con- 
stituents of  the  blood,  but  also  those  of  the 
entire  system,  about  8  per  cent,  of  it  being 
serum   albumen   and   serum   globulin.    It 
also  holds  in  solution  the  phosphates,  car- 
bonates, sulphates,  and  chlorides,  the  latter 
often  varying  greatly,  and  being  chiefly  re- 
sponsible for  the  isotonic  relation  of  cells 
and  serum.     In  cancerous  cachexia  a  dimi- 
nution of  carbonic  acid,  a  constantly  dimin- 
ished alkalinity,  and  an  increase  of  acid 
principles   of  the  blood  have  been  fully 
demonstrated,  pointing  in  all  probability 
to  the  existence  of  an  acid  intoxication. 
The  formation  of  the  corpuscular  elements 
of  the  blood  must  be  greatly  interfered 
with  when  metastases  occur  in  the  blood 
making  organs,  the  l:^nnphatic  tissue,  bone, 
marrow,  and  spleen,  which  probably  occur 


78   MEDICAL  ASPECTS  OF  CANCER 

more  frequently  than  is  generally  recog- 
nized. It  seems  that  the  toxic  secretion 
from  a  cancerous  mass  has  a  distinct  action 
upon  the  blood,  for  after  complete  removal 
there  is  often  observed  an  increase  of 
haemoglobin,  as  I  have  witnessed,  and  a 
high  leucocytosis  has  disappeared  after 
the  removal  of  schirrus  of  the  breast,  only 
to  return  again  with  the  recurrence  of  the 
tumor.  Abderhalden  states  that  in  from 
two  to  three  weeks  after  the  operative  re- 
moval of  cancer,  certain  defensive  fer- 
ments can  no  longer  be  found  in  the  serum. 
Many  laboratory  studies  have  been  made 
upon  the  chemistry  of  cancer  tissue,  seek- 
ing to  determine  the  nature  of  the  toxin 
produced,  and  its  experimental  effect  on 
animals,  but  thus  far  no  great  results  have 
been  obtained.  It  has  been  observed,  how- 
ever, by  Grruner  that  when  cancer  juice  is 
injected  intra-venously  a  marked  lympho- 
cytosis arises,  which  is  followed  by  the  ap- 
pearance of  large  mast  cell  myelocytes  in 


METABOLISM  OF  CANCER       79 

the  blood.  This  cancer  juice  is  supposed 
to  be  autotoxic  in  cancer  patients,  and  to 
comprise  toxic  albuminoids,  which  being  in 
quantities  too  great  to  be  quickly  neutral- 
ized ]3oison  the  system,  especially  the  blood 
and  the  hgematopoietic  organs. 

In  regard  to  the  real  bio-chemistry  of 
cancer,  we  are  still  greatly  in  the  dark. 
Vast  numbers  of  studies  and  researches 
have  been  made  to  determine  the  real  char- 
acter and  nature  of  the  bio-chemical 
changes  which  occur  in  cancerous  tissue, 
and  the  mere  recounting  of  the  reported 
findings  and  theories  elaborated  from  them 
would  occupy  far  more  time  than  can  be 
profitably  given  in  these  lectures.  Some 
have  claimed  very  positive  findings  which 
account  in  a  measure,  at  least,  for  the 
pathological  conditions,  while  others,  as 
Beebe,  state  that  ^  ^  the  chemical  study  of  tu- 
mors is  in  its  infancy.  We  have  scarcely 
proceeded  far  enough  to  know  where  the 
medical  problems  are,  nor  have  methods 


80   MEDICAL  ASPECTS  OF  CANCER 

now  available  been  perfected  to  sucb  an  ex- 
tent as  to  enable  a  decisive  experiment  to 
be  made.''  ^^No  phase  of  metabolism," 
says  lie,  **has  been  described  in  cancer 
which  does  not  have  a  counterpart  in  non- 
cancerous conditions.  This  applies  to 
such  questions  as  the  nutritive  relations 
between  the  cancer  cells  and  the  normal 
body  tissue,  to  the  nitrogenous  balance,  re- 
tention, elimination  of  sodium  chloride,  ex- 
cretion of  acetone,  the  relation  of  ammonia 
excretion,  and  a  possible  acidosis."  He 
adds,  however,  ^^Diet  doubtless  forms  an 
important  part  in  the  growth  of  cancer, 
possibly  even  in  the  origin  of  the  disease." 
It  is  encouraging,  therefore,  to  find  that 
this  able  and  careful  laboratory  investi- 
gator recognizes,  in  a  measure,  the  basic 
cause  of  diet,  toward  which  all  evidence 
points  so  strongly,  although  the  definite 
connection  may  not  yet  have  been  estab- 
lished by  laboratory  methods. 


METABOLISM  OF  CANCER       81 

In  all  our  study  in  regard  to  tlie  relation 
of  diet  to  cancer  it  must  be  remembered 
that  tbere  are  divers  elements  and  agencies 
-which  combine  to  produce  the  many  and 
various  disordered  conditions  of  the  body, 
to  vrhich  we  give  the  names  of  different 
diseases,  and  that  cancer  is  no  exception 
to  this  general  rule.     For  instance,  in  old- 
fashioned  gout  the  patient  may  have  con- 
sumed an  excess  of  Port  and  Madeira  wine 
for  years  before  the  system  finally  rebelled 
and  acute  gout  resulted;  and  among  the 
causes  for  the  systemic  reaction  we  know 
that  frequently  it  is  great  mental  strain  or 
shock  which  has  so  disturbed  metabolism 
that   the   wine   was   no   longer   tolerated. 
Much  the  same  is  true  in  regard  to  cancer 
and  nitrogenous   diet.     And  we   will   see 
later  that  mental  disturbance  and  nerve 
strain  or  shock  often  seem  to  be  causative 
elements;  also  that  constipation,  or  intes- 
tinal stasis,  is  so  common  in  cancer  sub- 


82   MEDICAL  ASPECTS  OF  CANCEE 

jects  tliat  it  must  be  looked  upon  as  one 
of  the  contributing  causes  among  others, 
to  be  mentioned  later. 

Although  it  is  quite  possible  that  many 
of  the  reported  bio-chemical  changes  found 
in  primary  cancerous  tissue  and  metas- 
tases may  not  be  of  etiological  importance, 
it  may  be  interesting  to  briefly  refer  to 
some  of  them  as  indicating  the  vital  altera- 
tion in  tissues  connected  with  what  we 
recognize  as  malignancy;  even  as  in  acute 
and  chronic  gout  the  affected  tissues  ex- 
hibit abnormal  conditions  in  regard  to 
uratic  deposit. 

Many  writers,  some  of  them  dating  back 
many  years,  agree  that  albuminous  con- 
stituents predominate  in  cancer  tissue,  and, 
as  in  actively  growing  structures  in  gen- 
eral, sugar  forming  substances  abound. 
Wolter  states  that  cancer  of  the  breast 
contains  20  per  cent,  more  nucleo-proteids 
than  the  normal  breast.  Casein  is  also 
present  in  breast  cancers,  and  the  abun- 


METABOLISM  OF  CANCER       83 

dance  of  fatty  matters,  contained  in  tlie 
cells  of  such  neoplasms,  is  well  known.  In 
regard  to  the  proteids,  Wolff,  after  many 
studies,  concludes  that  their  character  is 
identical  with  that  of  normal  tissues,  and 
it  is  only  the  quantitative  distribution  of 
these  that  differentiates  the  tumor  from 
the  physiological  tissue.  Wells  agrees 
with  others  that  there  is  no  very  distinc- 
tive character  in  the  bio-chemistry  of  ma- 
lignant tumors,  but  by  reason  of  their  ex- 
cessive chemical  component,  as  compared 
with  benign  tumors,  they  naturally  show  a 
high  content  of  nuclear  proteins;  they, 
therefore,  contain  a  high  proportion  of 
phosphorus  and  iron. 

Interesting  observations  have  also  been 
made  on  other  characteristics  of  cancerous 
tissues,  such  as  the  great  abundance  of  en- 
zymes of  great  variety  which  are  actively 
autolytic,  also  in  regard  to  certain  rela- 
tions of  cholesterin,  in  regard  to  which 
Ewing  has  recently  said,  *^  There  appears 


84   MEDICAL  ASPECTS  OF  CANCER 

to  be  sometliing  in  the  chemical  or  mechan- 
ical nature  of  the  irritation  of  cholesterin 
which  is  peculiarly  effective  in  producing 
atypical  proliferation  of  epithelium";  this 
has  been  found  to  be  no  less  than  65  per 
cent,  greater  in  quantity  in  fatty  deposits, 
as  in  the  mesentery,  in  subjects  of  cancer 
than  in  healthy  persons,  etc.,  etc.  It  would 
weary  you  to  no  purpose  to  attempt  to  re- 
fer further  to  the  bewildering  mass  of  re- 
search studies  in  connection  with  the  bio- 
chemistry of  cancer  which  are  found  in 
special  literature:  much  of  it  is  fragmen- 
tary and  some  of  it  contradictory,  but  all 
has  its  value  as  contributory  to  our  knowl- 
edge of  the  actual  conditions  developed  in 
connection  with  cancer  growth;  but  up  to 
the  present  time  it  cannot  be  claimed  that 
any  very  practical  results  have  been  thus 
attained  which  will  aid  us  in  treating  the 
disease. 

As  all  cell  life  and  proliferation  of  tis- 
sue depends  on  the  activity  of  the  cell  nu- 


METABOLISM  OF  CANCER       85 

clei,  miicli  attention  has  been  paid  to  the 
changes  found  in  them  and  the  behavior 
of  the  centrosomes  and  chromosomes,  all 
of  which  is  too  technical  for  us  to  consider 
here:  suffice  to  say,  however,  that  several 
observers  have  demonstrated  heterotyioic 
mitosis  in  malignant  tumors,  and  that  his- 
tologic examination  confirms  what  other 
judgment  has  indicated,  namely,  that  the 
cancer  cell  differs  from  a  normal  tissue  cell 
mainly  in  its  aberrant  action  under  some 
stimulus,  probably  derived  from  the  ani- 
mal   fluids    by    which    it    is    surrounded. 
Thus  we  come  back  to  our  original  propo- 
sition, for  these  fluids  are,  of  course,  but  a 
reflection  of  the  nutrition  of  the  body  or 
diet,  as  modified  by  the  action  of  the  va- 
rious organs,  including  the  internal  secre- 
tions; all  this  is  influenced  again  by  the 
action  of  the  nervous  system. 

It  is  difficult  to  produce  definite  proof  in 
regard  to  the  influence  of  nervous  and 
mental  strain  and  shock  in  the  production 


86   MEDICAL  ASPECTS  OF  CANCER 

of  cancer,  but  careful  observers  have  long 
claimed  that  there  is  such  an  influence, 
and  from  what  I  have  seen  I  am  firmly 
convinced  that  in  some  way  these  condi- 
tions often  do  so  disturb  the  metabolism, 
or  otherwise  operate,  in  such  a  manner  that 
cancer  results.  The  influence  of  the  mind 
upon  the  body  is  unquestionable,  as  has 
been  so  fully  illustrated  by  Tuke,  and  from 
what  I  have  observed  I  cannot  doubt  but 
that  the  mental  depression  common  in 
those  with  the  beginning  of  a  process 
which  they  fear  might  result  in  active  can- 
cer, has  much  to  do  with  accelerating  its 
growth;  whereas,  on  the  other  hand,  the 
hopefulness  which  can  arise  with  the  at- 
tempt to  change  the  diseased  process  by 
diet  and  proper  medication,  has  much  to 
do  with  the  favorable  results  which  may 
follow  in  suitable  cases.  In  the  same  way 
the  constant  fear  of  recurrence  after  op- 
erative removal  can  have  its  share  in  in- 
ducing   and    perpetuating    the    metabolic 


METABOLISM  OF  CANCEE       87 

error  wliicli  excites  the  tissues  to  renewed 
cancerous  action.  I  know  tliat  some  of 
you  will  think  that  this  is  fanciful  theoriz- 
ing, but  many  a  scientific  fact,  in  many 
branches  of  science,  has  been  worked  out 
from  a  theory  which  at  first  has  seemed 
fanciful. 

We  will  now  consider  some  of  the  data 
which  have  been  recorded  in  regard  to  the 
relation  of  the  secretions  and  excretions 
of  the  body  to  cancer,  including  the  inter- 
nal secretions. 

Much  labor  has  been  expended,  by  very 
many  observers,  upon  the  analysis  of  the 
urine  in  connection  with  cancer,  as  that 
might  be  expected  to  reveal  the  metabolic 
changes  connected  with  this  disease. 
While  many  departures  from  the  normal 
have  been  reported,  and  while  under  com- 
plete volumetric  analysis  the  urine  of  a 
subject  of  cancer  is  rarely  if  ever  that  of 
health,  it  cannot  be  said  that  any  definite 
and  specific  changes  have  been  established 


88    MEDICAL  ASPECTS  OF  CANCER 

whicli  may  not  be  found  in  tliose  without 
cancer;  although  there  have  been  several 
who  have  so  claimed  even  diagnostic  signs 
from  the  urine.  But  minute,  volumetric 
analysis  is  often  of  great  service  in  guid- 
ing the  nutrition  and  medication  of  these 
patients,  and  gross  errors  are  continually 
met  with,  which  have  the  greatest  bearing 
on  the  case  in  hand,  as  indicating  very 
great  metabolic  disturbance:  and  con- 
stantly the  urinary  excretion  will  be  found 
to  be  extremely  deficient,  both  as  to  its 
quantity  and  its  total  solid  elimination. 
In  one  very  interesting  case  of  cancer  of 
the  breast,  in  a  stout,  flabby  lady,  near  55, 
in  private  practice,  the  total  daily  quan- 
tity of  the  urine,  measured  for  weeks,  is 
always  very  far  below  the  normal  amount ; 
and  in  spite  of  active  medication  it  seems 
almost  impossible  to  raise  the  total  daily 
solids  excreted  in  the  urine,  to  more  than 
one-half  of  that  called  for  by  the  weight  of 
the  patient.     We  may  now  briefly  consider 


METABOLISM  OF  CANCER       89 

some  salient  points  reported  in  connection 
with  the  urine  in  cancer. 

As  remarked  in  regard  to  other  elements 
in  the  study  of  the  disease,  it  would  be 
very  desirable  to  have  a  knowledge  of  the 
urine  in  pre-cancerous  stages  of  health,  or 
ill-health,  and  also  in  very  early  cancer, 
likewise  after  surgical  operations,  that  we 
might  better  understand  the  metabolic 
changes  which  lead  up  to  malignant  dis- 
ease; but  unfortunately  these  are  exceed- 
ingly few  and  unsatisfactory,  and  almost 
all  the  studies  have  been  made  in  advanced 
cancer,  and  often  when  the  disease  has  af- 
fected vital  organs,  or  when  by  its  own 
poison  it  has  disturbed  the  workings  of  the 
economy. 

Many  observers  agree  that  there  is  a 
disturbance  of  proteid  metabolism  in  can- 
cer, and  dependent  upon  this  many  devia- 
tions from  normal  are  found  in  the  urine, 
some  of  which  in  turn  are  related  to  the  in- 
anition which  occurs.     The  urea  is  almost 


90   MEDICAL  ASPECTS  OF  CANCER 

invariably  diminished,  often  very  greatly, 
as  I  have  verified  time  and  again  in  many 
cases. 

A  number  of  studies  have  been  made 
upon  the  nitrogen  partition  in  cancer  by 
Einhorn,  Kahn,  and  Rosenblum,  also  by 
De  Bloeme,  Swart,  and  Terwen,  and  oth- 
ers, showing  an  increase  in  colloid  nitro- 
gen, to  more  than  double  the  normal 
amount,  increased  elimination  of  xanthin, 
oxyproteic  acid,  and  urinary  ammonia,  to- 
gether with  many  other  changes  which 
show  that  disintegration  of  the  protein  ele- 
ments is  very  imperfect  and  often  excess- 
ive. An  interesting  statement  is  made  by 
Blumenthal  that  the  oxyproteic  acids  are 
increased  even  in  very  early  cancer,  and 
independently  of  the  size  of  the  tumor  and 
degree  of  cachexia,  seemingly  showing 
them  to  have  some  specificity  for  cancer, 
because  they  have  not  been  found  in  other 
forms  of  malignancy.  He  also  states  that 
urobilin  is  increased  in  a  large  proportion 


METABOLISM  OF  CANCER       91 

of  cases  of  cancer,  especially  when  ca- 
chexia is  setting  in,  and  is  a  grave  symp- 
tom. 

Reid,  wlio  lias  confirmed  many  of  these 
matters    reported    by    others,    says:     "I 
have  found  an  increase  of  amino-acid  ni- 
trogen in  practically  every  case  of  cancer 
I  have  examined";  .  .  .  ''Hence  we  can 
only  infer  that  in  cancer,  the  liver,  while 
not  involved  in  the  disease,  is  still  unable, 
for  some  reason,  to  perform  its  functions 
in  synthetizing  urea.     The  organ  is  func- 
tionally injured,  no  lesions  having  been 
found  to  explain  its  insufficiency";  or  pos- 
sibly .  .  .  ''cancerous  subjects  form  pro- 
teids  which  the  liver  is  unable  to  deal  with, 
so  that  they  are  excreted  unchanged,  or 
nearly  so."     Degrez  has  made  confirma- 
tory studies  along  these  lines,  and  found 
the  nitrogen  disintegration  very  imperfect, 
with  increase  of  the  ammonia  fraction  of 
nitrogen,  and  increased  elimination  of  xan- 
thin  bases.     He  states  that  "the  toxicity 


92   MEDICAL  ASPECTS  OF  CANCER 

of  the  urine  is  increased  apparently  as  the 
result  of  the  presence  of  substances  which 
have  not  been  fully  oxidized. ' ' 

Notable  changes  have  also  been  recorded 
concerning  the  sulphur  elements  in  the 
urine,  with  a  great  increase  in  neutral  (un- 
oxidized)  sulphur  and  a  considerable  ex- 
cess of  sulpho-cyanic  acid,  together  with 
an  increase  in  sulphates  and  indican 
showing  the  results  of  intestinal  fermenta- 
tion of  protein  elements,  which  also  I  have 
constantly  observed. 

The  chlorides,  on  the  other  hand,  are,  as 
a  rule,  diminished  in  cancer,  especially  in 
its  late  stages,  when  there  is  inanition  or 
kidney  insufficiency;  and  probably  any 
change  in  them  has  only  a  relation  to  the 
nutrition  of  the  patients,  for  the  chlorides 
come  from  the  food  and  are  commonly  an 
index  of  the  amount  of  nutriment  absorbed. 
Robin  finds  some  relation  between  the  ex- 
cretion of  chlorine  and  nitrogen,  according 


METABOLISM  OF  CANCER       93 

to  the  stage  or  degree  in  which  the  system 
is  affected  by  cancer. 

The   phosphates   are   known   to   be   in- 
creased in  the  nrine  of  cancer  subjects,  al- 
though irregularly  and  in  an  inverse  ratio 
to    the   chlorides;    as   inanition   increases 
there  is  greater  autolysis  of  cellular  struc- 
ture, and  the  nuclei  ^deld  an  excess  of  phos- 
phates, which  are  excreted  in  the  urine. 
A  more  or  less  general  demineralization 
of  the  system  through  the  urine  has  been 
observed  by  several,  and  has  been  recog- 
nized as  a  significant  matter,  and  is  of  spe- 
cial importance  when  we  consider  what  an 
important  part  minerals  take  in  the  nour- 
ishment of  cell  life. 

AVhile  the  changes  which  have  been  ob- 
served in  the  urine  in  connection  with  can- 
cer are  not  wholly  pathognomonic,  but  oc- 
cur in  connection  with  other  diseased 
states  of  the  system,  so  that  none  of  them 
can  be  accepted  as  diagnostic  of  malignant 


94  MEDICAL  ASPECTS  OF  CANCER 

disease,  tliey  all  have  a  certain  significance 
as  indicating  the  metabolic  changes  which 
accompany  and,  as  we  believe,  have  much 
to  do  with  the  etiology  of  cancer;  and,  as 
stated  before,  a  careful,  systematic,  and 
frequently  repeated  volumetrical  analysis 
of  the  urine  certainly  assists  greatly  in  the 
proper  management  of  these  cases,  that  is 
when  the  departures  from  normal  are  care- 
fully studied  and  correctly  interpreted. 

The  saliva,  and  its  action,  constitutes  a 
very  important  part  in  the  process  of  di- 
gestion, and  consequently  of  metabolism 
and  the  genesis  of  cancer ;  far  too  little  at- 
tention, however,  has  been  paid  to  it  prac- 
tically, in  ordinary  life  or  disease,  al- 
though there  have  been  many  laboratory 
studies  and  writings  on  the  physiological 
action  of  this  secretion;  but  I  have  not 
been  able  to  find  in  literature  any  investi- 
gations relating  to  its  condition  in  cancer. 
And  yet  the  experience  and  writings  of 
Mr.    Fletcher    and    others    have    demon- 


METABOLISM  OF  CANCER       95 

strated  wonderful  results  from  perfect 
mastication  and  thorough  insalivation,  and 
a  careful  consideration  of  digestion  must 
convince  every  one  of  the  importance  of 
this  secretion  in  connection  with  nutrition, 
both  in  health  and  disease. 

Our  time  does  not  permit  of  more  than  a 
brief  allusion  to  the  subject,  but  in  cancer 
patients  I  have  so  constantly  found  the 
salivary  secretion  acid,  and  often  strongly 
so,  instead  of  the  normal  alkaline  or  neu- 
tral, that  I  cannot  but  believe  that  this  con- 
dition has  some  bearing  upon  the  subject 
which  we  are  studying;  the  saliva  also  is 
apt  to  be  acid  in  diabetes,  which  is  closely 
allied  to  cancer.  It  is  to  be  remembered 
that  the  saliva,  which  amounts  in  health  to 
between  one  and  two  quarts  daily,  varying 
somewhat  with  the  food,  is  not  wholly  for 
the  purpose  of  lubricating  the  mouth  and 
facilitating  deglutition,  but  its  enzymes, 
ptyalin  and  maltase,  effect  radical  and  im- 
portant changes   in  the   starchy  matters 


96   MEDICAL  ASPECTS  OF  CANCER 

consumed.  It  is  also  to  be  remembered 
that  the  latter  cannot  be  acted  upon  by  the 
stomach  secretions,  but  must  be  passed  on 
to  the  influence  of  the  pancreatic  fluid  in  the 
small  intestine,  in  case  the  action  of  the 
saliva  has  not  been  effective;  hence  there 
follows  delayed  and  imperfect  digestion, 
faulty  metabolism,  deranged  nutrition,  and 
possibly  tumor  growth.  The  importance, 
therefore,  of  very  slow  eating,  thorough 
mastication,  and  perfect  insalivation  can- 
not be  too  strongly  insisted  on,  both  as  an 
element  of  importance  in  the  prevention 
of  cancer,  and  also  as  a  curative  measure 
in  patients  in  whom  the  diseased  process 
has  already  manifested  itself. 

The  so-called  internal  secretions  have 
also  been  the  subject  of  much  research  and 
speculation  of  late  years,  in  regard  to  their 
influence  on  metabolism  and  the  life  proc- 
esses of  the  economy,  and  many  studies 
have  been  made  concerning  their  connec- 
tion with  cancer,  which   cannot  be  long 


METABOLISM  OF  CANCER       97 

dwelt  upon  now ;  but  there  seems  to  be  lit- 
tle doubt  but  that  the  secretions  of  the 
ductless  glands  in  common  have  much  to 
do  with  regulating  the  metabolism  of  the 
cells.  We  know,  for  instance,  that  disease 
of  the  pituitary  body  produces  bone  dis- 
order, resulting  in  gigantism,  that  thyroid 
derangement  results  in  myxoedema,  and 
that  disease  of  the  supra-renal  capsules 
gives  rise  to  Addison's  disease,  or  bronzed 
skin;  and  it  is  not  at  all  impossible  that 
the  derangement  of  secretion  of  one  or 
more  of  these  and  other  organs  may  be  an 
element  in  the  disordered  action  of  certain 
epithelial  cells,  resulting  in  cancer,  nar- 
rower calls  attention  to  the  fact  that  can- 
cer is  essentially  a  disease  of  that  period 
of  life  when  certain  of  the  ductless  glands 
lose  their  normal  function,  this  loss  entail- 
ing related  changes  in  the  whole  chain  of 
interrelated  functions  of  the  ductless 
glands. 

The  supra-renal  glands  by  their  secre- 


98   MEDICAL  ASPECTS  OF  CANCEE 

tion  have,  as  we  know,  great  vaso-con- 
strictor  influence,  and  their  complete  re- 
moval is  followed  by  death ;  it  is  more  than 
possible  that  some  failure  in  this  secretion 
allows  the  exuberant  blood  to  supply  can- 
cerous growths.  Sajous  says:  ^^ Certain 
growths,  particularly  the  more  malignant 
forms  of  sarcoma  and  carcinoma,  seem 
closely  connected  with  adrenal  insufficiency 
and  its  normal  consequences,''  and  there 
have  been  some  clinical  and  research  data 
confirming  such  a  conclusion.  Sajous  fur- 
ther says,  ^^The  adrenals,  as  supporters  of 
the  thyroid  apparatus  in  the  defensive 
process,  and  in  sustaining  oxidation,  metab- 
olism, and  nutrition,  seem  to  otfer  a  new 
clew  to  the  pathogenesis  and  treatment  of 
cancer  that  is  worthy  of  further  inquiry.'* 
The  pancreas  has  been  thought  to  have 
some  influence  in  a  perverted  metabolism 
leading  to  cancer,  Kahle  stating  that  there 
is  a  retention  of  silica  in  that  organ  in  can- 
cer patients,  to  even  double  the  normal 


METABOLISM  OF  CANCER       99 

amount.  A  treatment  of  cancer  intro- 
duced by  Beard,  also  strongly  presented  by 
Saleeby,  by  trypsin  and  amylopsin,  the  en- 
zymes of  the  pancreatic  fluid,  excited  some 
attention  a  while  ago;  but  unfortunately 
no  satisfactory  results  have  thus  far  been 
obtained  from  this  line  of  medication,  as 
was  fully  demonstrated  by  Bainbridge  at 
the  New  York  Skin  and  Cancer  Hospital, 
in  one  hundred  cases. 

The  pituitary  gland  by  its  secretion  has 
undoubtedly  some  coordinating  power, 
with  the  adrenals  and  thyroid,  over  the 
processes  of  metabolism,  and  a  number  of 
observers  have  regarded  it  as  of  impor- 
tance in  connection  with  the  genesis  of  can- 
cer. Little  has  recently  reported  some 
cases  of  cancer  in  which  pituitary  extract 
with  that  of  the  pancreas  has  produced  re- 
markable results. 

The  thyroid  is  now  recognized  as  play- 
ing an  important  part  in  assisting  metab- 
olism, and,  like  the  adrenals  and  pituitary, 


100    MEDICAL  ASPECTS  OF  CANCER 

its  complete  removal,  with  the  para- 
thyroids, in  animals  is  followed  by  death. 
While  the  study  of  the  hormones  is  still  in 
its  infancy,  there  seems  to  be  no  question 
but  that  the  endocrinous  glands  act  con- 
jointly, the  one  influencing  the  other,  and 
that  together  they  exert  a  very  great  influ- 
ence in  the  life  processes  of  the  body  and 
on  the  behavior  of  its  component  cells. 
The  thyroid  has  been  shown  to  be  one  of 
the  main  factors  in  the  management  of  cal- 
cium within  the  body,  which  is  believed  to 
be  an  element  in  cancer,  and  enhances  the 
catabolism  of  toxic  wastes,  which  are  etio- 
logic  elements  in  this  disease.  Many  have 
reported  favorably  on  the  effect  of  thyroid 
feeding  in  cancer,  and  after  an  experience 
with  it  in  many  cases  I  am  convinced  that 
it  has  been  one  of  the  means  which  con- 
tributed to  the  good  results  obtained.  On 
the  other  hand  it  has  been  claimed  by  Stu- 
art-Low that  the  surgical  removal  of  the 
thyroid,  or  part  of  it,  or  ligation  of  the 


METABOLISM  OF  CANCER     101 

thyroid  blood  vessels  lias  arrested  cancer, 
in  several  cases. 

Thymus  gland  feeding  has  also  been  re- 
ported on  favorably  by  a  number  of  ob- 
servers  (Eohdenburg,  Bullock,  and  John- 
son, also  Gwyer),  they  reporting  relief  of 
pain  and  improved  general  conditions,  no- 
tably gain  in  weight  and  increased  haemo- 
globin  in   all   but   one    of   sixteen   cases, 
though  some  of  them  died.     On  the  other 
hand  Ross  reports  most  unfavorably  on  the 
administration  of  thymus,  which  he  gave 
to   some  inoperable   and  hopeless   cancer 
cases,  in  which  he   said  that  in  two   or 
three  weeks  the  tumors  had  quadrupled 
in  size  and  the  condition  of  the  patients 
was  very  much  worse;  the  same  occurred 
also  when  some  cancer  patients  were  given 
calcium  salts  freely.     Ross  makes  some  in- 
teresting suggestions  in  regard  to  the  thy- 
mus, and  its  relation  to  calcium  and  mag- 
nesium; these  latter  are  freely  utilized  in 
the  growth  of  bone  up  to  the  age  of  twenty- 


102   MEDICAL  ASPECTS  OF  CANCER 

ISiVe  years,  by  which  time  the  thymus  gland 
has  quite  disappeared;  but  after  this  time 
these  salts  tend  to  have  pathological  rela- 
tions in  various  tissues,  and  also  cancer 
becomes  frequent. 

The  internal  secretions  of  the  testicles 
and  ovaries  are  also  thought  to  have  some 
share  in  metabolic  processes,  and  observa- 
tions have  been  made  in  regard  to  their  in- 
fluence in  cancer.  Thus  Cahen  reported 
that  Beatson's  operation  of  castration  for 
cancer,  done  first  in  1896,  had  been  re- 
peated by  many,  so  that  Lott  had  reported 
99  cases  including  his  own.  Of  these  in 
23.2  per  cent,  the  operation  caused  a  dis- 
tinct improvement  in  the  cancer.  In  15 
cases  the  improvement  persisted  for  a 
year,  in  4  cases  for  4%  years  and  in  one 
case  for  over  5  years.  Cahen  operated  on 
seven  women  with  remarkable  results;  in 
two  cases  life  was  prolonged  4  and  6  years 
respectively.  Others,  however,  have  shown 
by  statistics,  that  damage  to  the  ovaries  by 


METABOLISM  OF  CANCEE     103 

disease,  or  their  removal  by  operation, 
greatly  increases  the  proclivity  to  cancer. 
Several  writers  have  connected  cancer 
with  the  waning  of  the  sexual  powers,  and 
the  suggestion  is  made  by  Sherrington  and 
Copeman  that  in  the  period  which  ante- 
dates the  cancer  age,  the  reproductive 
glands,  by  means  of  internal  secretions, 
are  able  to  inhibit  the  growth  of  cancer. 

In  looking  back  over  what  has  been  ob- 
served in  regard  to  the  secretions,  includ- 
ing those  of  ductless  glands,  we  see  that 
very  strong  evidence  has  accumulated  to 
show  that  they  have  a  very  intimate  con- 
nection with  the  development  of  cancer,  as 
was  to  be  expected,  since  they  are  very  im- 
portant factors  in  connection  with  metab- 
olism. 

We  have  also  seen  that  while  there  has 
not  been  demonstrated  any  very  definite 
and  specific  change  in  the  bio-chemistry  of 
tumors,  and  no  specific  enzymes  or  poison 
secreted  by  cancer  cells  which  can  com- 


104   MEDICAL  ASPECTS  OF  CANCER 

municate  the  disease,  there  is  evidence  that 
the  disordered  cells  secrete  a  something 
which  deranges  the  blood  and  ultimately 
tends  to  end  life ;  for  the  blood  in  advanc- 
ing cancer  undergoes  very  radical,  degen- 
erative changes,  some  of  which  improve 
decidedly  when  a  cancerous  mass  is  re- 
moved surgically,  but  return  with  the  re- 
growth  of  the  tumor. 

We  have  also  seen  that  the  urine  mani- 
fests alterations  which  show  a  disturbed 
metabolism,  and  that  the  saliva  has  an  ab- 
normal acidity  leading  to  disturbed  amy- 
laceous digestion. 

We  have  further  seen  that  there  is  evi- 
dence that  the  internal  secretions  of  many 
organs,  probably,  through  their  influence 
on  metabolism,  are  factors  of  importance 
in  connection  with  the  genesis  and  cure  of 
cancer.  Little  well  says,  ^ '  Cancer  is  a  dis- 
ease of  disordered  nutrition,  as  a  result  of 
which  cells  revert  to  a  primitive  stage, 
which  permits   reproduction.     The   disor- 


METABOLISM  OF  CANCER     105 

dered  nutrition  is  due  to  relative  li^qDo- 
f unction  of  the  ductless  glands."  In  later 
lectures  we  shall  consider  the  basic  causes 
of  this  deranged  nutrition,  which,  as  has 
been  already  intimated,  has  much  to  do 
with  diet  and  the  various  elements  of  life 
which  tend  to  induce  functional  and  other 
derangements  of  the  system,  many  of 
which  are  included  in  and  influenced  by 
what  we  term  the  advance  of  civilization. 


LECTUEE  IV 

RELATION    OF    DIET   TO    CANCER 

In  our  earlier  lectures  we  saw  that  cancer 
was  undoubtedly  a  diseased  action  of  orig- 
inally normal  tissue  cells,  due  largely  to 
perverted  metabolism,  the  special  features 
of  which  were  brought  out  last  week.  In 
the  second  lecture  we  studied  the  fre- 
quency and  geographical  distribution  of 
cancer,  which  was  found  to  be  very  differ- 
ent for  various  peoples  in  diverse  sections 
of  the  earth,  and  which  we  saw  was  pro- 
portioned in  a  great  measure  according  to 
their  diet  and  mode  of  life.  In  this  lecture 
we  will  examine  into  the  details  of  these 
matters  more  particularly,  and  endeavor  to 
discover  their  practical  bearing  upon  the 
prevention  and  cure  of  cancer. 

106 


EELATION  OF  DIET  107 

For  the  proper  understanding  of  the  re- 
lation of  food  and  drink  to  cancer,  and  the 
satisfactory  application  of  the  principles 
involved,  it  is  necessary  to  bear  well  in 
mind  the  chemistry  of  the  body  and  the  re- 
lation to  nutrition  of  the  various  elements 
which  contribute  to  form  healthy  and  dis- 
eased tissues. 

The  human  body  is  composed  of  some  fif- 
teen different  elements,  the  relative  pro- 
portions of  which  may  be  understood  by 
the  following  table  from  Sherman,  which 
represents  probably  as  approximately  cor- 
rect an  average  as  any  that  can  be  given. 

COMPOSITIOX  OF  THE  HUMAN  BODY 

Per  cent. 

Oxygen,  about 65 

Carbon,  about   18 

Hydrogen,  about 10 

Nitrogen,  about 3 

Calcium,  about   2 

Phosphorus,  al30ut   1 

Potassium,  about   0.35 

Sulphur,  about   0.25 

Sodium,   about    0.15 

Chlorine,    about    0.15 


108   MEDICAL  ASPECTS  OE  CANCER 

Per  cent. 

Magnesium,  about    0.05 

Iron,  about , . . . .     0.004 


Iodine 

Fluorine 

Silicon 


very 

minute 

traces 


As  the  actual  composition  of  the  body  is 
changing  day  by  day,  through  the  activities 
of  the  system,  so  that  it  is  commonly  be- 
lieved that  after  some  years  all  the  tissues 
are  entirely  renewed,  the  daily  wear  and 
tear,  as  also  the  material  expended  in  heat 
and  activity,  must  be  supplied  by  the  diet. 
For  the  ordinary  requirements  of  the  sys- 
tem, in  health,  the  appetite  serves  as  a 
guide,  which  should  suffice  in  man  as  in  wild 
animals,  to  preserve  the  balance  of  nutri- 
tion. But  man  has  also  the  power  to  grat- 
ify the  taste,  which  must  be  recognized  in 
our  study  as  distinct  from  the  satisfying 
of  the  appetite;  and  the  refinements  of 
civilization  have  added  so  greatly  to  the 
temptation  of  wrong  and  over-eating  and 
drinking,  as  they  have  to  many  other  temp- 


KELATION  OF  DIET  109 

tations,  that  it  is  questionable  if  reason, 
and  what  is  often  spoken  of  as  the  natural 
instinct  for  food,  can  be  trusted  in  man- 
kind. 

It  is  to  be  remembered  that  the  advance 
of  civilization,  and  the  facilities  of  trans- 
portation and  cold  storage,  have  brought 
from  f aT  and  near  an  innumerable  number 
and  variety  of  articles  for  food  and  drink, 
including  condiments,  which  bear  no  rela- 
tion to  the  few  simple  articles  formerly 
consumed ;  even  the  fruits  which  we  eat  are 
rarely  ripened  fully  by  nature,  but  are 
picked  more  or  less  green,  and  undergo  an 
artificial  ripening  without  the  action  of  the 
sun,  which  is  really  akin  to  decay.  In  the 
combination  and  preparation  of  articles  of 
food  also,  so-called  civilization  and  refine- 
ment have  made  the  greatest  departure 
from  the  simple  life  of  the  aborigines,  who 
are  free  from  cancer,  and  with  increasing 
ease  and  wealth  throughout  the  civilized 
world  more  and  more  individuals  are  shar- 


110   MEDICAL  ASPECTS  OF  CANCER 

ing  in  unnecessary  and  often  harmful  in- 
dulgences, more  and  more  freely:  and  this 
is  especially  true  of  animal  food,  the  con- 
sumption of  which  has  increased  so  greatly. 
Many  other  elements  likewise  enter  into 
the  matter  of  the  digestibility  and  conse- 
quent nutritive  power  of  food  and  drink; 
such  are  nervous  conditions,  rapid  eating, 
imperfect  mastication  and  insalivation, 
heat  and  cold,  character  of  the  air  breathed, 
micro-organisms,  etc.,  and  all  the  various 
causes  which  may  derange  the  action  of  the 
digestive  organs  and  so  prevent  the  per- 
fect metabolism  between  nutrient  material 
and  the  cells  of  the  body,  as  I  tried  to  show 
you  in  some  former  lectures. 

As  is  well  known,  the  nutrition  of  man  is 
supplied  by  the  organic  substances,  protein, 
carbohydrates,  and  fat ;  these  are  found  in 
various  combinations  in  animal  and  vege- 
tarian foods,  and  as  a  rule  contain  also 
much  of  the  inorganic  or  mineral  sub- 
stances necessary  for  the  system;  all  of 


RELATION  OF  DIET  111 

these  with  water,  and  its  salts,  and  oxy- 
gen, supplied  by  the  lungs,  unite,  through 
anabolism  and  catabolism,  to  build  and 
maintain  tlie  human  body  in  health. 

It  is  also  well  known  that  in  order  to  pre- 
serve health  and  proper  weight  there  must 
exist  in  the  economy  a  certain  balance  or 
equilibrium  between  the  amount  of  the  in- 
gesta  and  excreta,  representing  the  various 
elements  which  enter  into  nutrition;  thus 
we  speak  of  a  nitrogen  equilibrium,  a 
carbo-hydrate  equilibrium,  a  phosphorus 
equilibrium,  and  iron  equilibrium,  etc., 
some  of  which  are  disturbed  continually  in 
ill  health  and  in  various  diseases,  including 
cancer,  as  has  been  shown  in  our  last  lec- 
ture. 

Until  quite  recently  the  principles  of  diet 
(even  if  not  often  carried  out  in  practice) 
have  been  established  on  lines  laid  down  by 
Carl  Voit,  of  Munich ;  this  eminent  physiol- 
ogist, after  studying  the  dietary  habits  of 
various  classes  of  workers,  claimed  that 


112   MEDICAL  ASPECTS  OE  CANCER 

the  adult  man  of  150  pounds,  doing  mod- 
erate muscular  work,  requires  daily  118 
grams  of  protein  or  albuminous  food,  56 
grams  of  fat,  and  500  grams  of  carbo- 
hydrate, with  a  total  fuel  value  of  3000 
large  calories,  in  order  to  maintain  the 
body  in  equilibrium.  But  the  remarkable 
and  scientific  experiments  of  Chittenden 
have  demonstrated  beyond  question  that 
perfect  bodily  and  nitrogenous  equilibrium 
can  be  maintained  with  one-third  of  the 
amount  of  protein  called  for  by  the  Voit 
standard,  and  with  a  total  value  in  the  diet 
of  only  about  1600  calories,  or  about  one- 
half  of  that  indicated  as  necessary  by  Voit. 
These  experiments  were  based  on  a  group 
of  ^Ye  men  of  varying  ages,  professors  and 
instructors  at  Yale,  thirteen  volunteers 
from  the  Hospital  Corps  of  the  United 
States  Army,  and  eight  students  in  Yale, 
all  thoroughly  trained  athletes,  twenty-six 
in  all. 

It  would  be  quite  beyond  the  scope  of 


RELATION  OF  DIET  113 

tliis  lecture  to  enter  at  all  into  tlie  intricate 
questions  connected  with  the  metabolism 
of  nitrogenous  and  other  foods,  but  Chit- 
tenden has  well  put  the  reasons  ^'why 
prominence  is  given  to  the  establishment 
of  nitrogenous  equilibrium  and  why  the 
proteid  intake  assumes  a  greater  impor- 
tance than  the  daily  amount  of  fat  and  car- 
bohydrate consumed.  Fats  and  carbo- 
hydrates when  oxidized  in  the  body  are 
ultimately  burned  to  simple  gaseous  x^rod- 
ucts,  viz.,  carbonic  acid  and  water.  Hence 
these  waste  products  are  easily  and  quickly 
eliminated  and  cannot  exercise  much  dele- 
terious influence,  even  when  formed  in  ex- 
cess. .  .  .  With  protein  foods,  on  the  other 
hand,  the  story  is  quite  different.  These 
substances  when  oxidized  yield  a  row  of 
crystalline,  nitrogenous  products  which  ul- 
timately pass  out  of  the  body  through  the 
kidneys.  Prior  to  their  excretion,  how- 
ever, these  products — frequently  spoken  of 
as  toxins — float  through  the  body  and  may 


114  MEDICAL  ASPECTS  OF  CANCER 

exercise  more  or  less  of  a  deleterious  influ- 
ence upon  tlie  system,  or,  being  tempora- 
rily deposited,  may  exert  some  specific  or 
local  influence  that  calls  for  speedy  re- 
moval. Hence  the  importance  of  restrict- 
ing the  production  of  these  bodies  to  the 
minimal  amount,  owing  to  their  possible 
physiological  effect  and  the  part  they  are 
liable  to  play  in  the  causation  of  many  dis- 
eased conditions.'' 

When  we  consider  the  small  share  which 
nitrogen  plays  in  the  composition  of  the 
human  frame,  as  shown  in  the  table  pre- 
sented, only  three  per  cent.,  it  is  easy  to 
see  how  an  excess  of  nitrogenous  food 
must  necessarily  either  pass  off  unassim- 
ilated  or  undergo  imperfect  metabolism, 
and  so  derange  the  general  metabolism; 
and  this  is  found  to  be  the  case  in  many 
conditions  of  disease,  and,  as  has  been 
shown,  in  cancer.  Chalmers  Watson  and 
others  have  shown  in  a  most  remarkable 
manner,  by  animal  experiments,  that  an 


EELATION  OF  DIET  115 

excessive  meat  diet  alters  very  materially 
the  microscopic  structure  of  very  many 
organs  and  portions  of  tlie  body. 

Beneke,  who  is  often  quoted,  was  one  of 
the  first  to  seriously  consider  the  actual 
diet  beneficial  in  cancer,  his  observations 
dating  back  to  1875  upon  material  in  the 
service  of  Esmarck  and  Oldehop,  who 
treated  patients  according  to  his  plan. 
While  the  diet  he  gives  is  not  wholly  vege- 
tarian, he  limits  the  nitrogenous  intake 
very  greatly,  and  reported  some  very 
favorable  results,  with  the  complete  dis- 
appearance of  some  malignant  new  forma- 
tions. 

Eeferring  now  to  the  data  presented  in 
the  second  lecture,  in  regard  to  the  fre- 
quency and  geographical  distribution  of 
cancer,  we  can  understand  better,  on  scien- 
tific grounds  some  of  the  reasons  why  can- 
cer is  so  steadily  increasing  in  civilized 
communities,  and  why  in  some  sections  of 
the  earth  it  is  less  common,  while  certain 


lie  MEDICAL  ASPECTS  OF  CANCER 

aborigines  have  seemed  to  be  almost  im- 
mune. 

We  found  that  in  England  the  per  capita 
consumption  of  meat  was  130  pounds  per 
year,  and  that  it  had  doubled  during  the 
past  fifty  years,  while  during  the  same  pe- 
riod cancer  had  increased  four  fold;  but  in 
Ireland,  where  the  meat  consumption  was 
estimated  in  1895  at  only  40  pounds  per 
capita,  or  less  than  one-third  that  in  Eng- 
land, the  cancer  death  rate  is  very  much 
lower,  not  much  over  one-half.  We  found 
that  in  Italy,  where  the  per  capita  con- 
sumption of  meat  was  the  smallest  of  any 
European  country  the  cancer  death  rate 
was  almost  the  lowest.  Also  that  in  cer- 
tain other  countries,  where  vegetarianism 
was  the  rule,  cancer  was  very  infrequent, 
while  among  certain  aborigines  the  disease 
was  practically  unknown;  but  we  found 
also  that  in  both  the  latter  classes  of  indi- 
viduals cancer  has  slowly  increased,  in 
proportion  as  the  inhabitants  of  different 


KELATION  OF  DIET  117 

sections  had  come  under  the  influence  of 
modern  civilization,  and  adopted  the  di- 
etary and  other  habits  of  foreigners. 

In  the  United  States  cancer  has  certainly 
increased  very  greatly  during  the  last  fifty 
years,  and  statistics  were  presented  show- 
ing that  in  seven  of  the  largest  cities,  dur- 
ing the  past  five  years,  the  number  of  can- 
cer deaths  had  augmented  between  seven 
and  eight  per  cent.  It  is  known  that  the 
consumption  of  meat  here  has  increased 
steadily,  until  in  a  communication  from  the 
Bureau  of  Agriculture  in  Washington  we 
learn  that  it  had  recently  reached  the  enor- 
mous amount  of  172  pounds  per  capita 
yearly,  much  more  than  in  England. 

Cancer  has  been  repeatedly  spoken  of  as 
a  disease  of  civilization,  and  there  are 
many  other  elements  besides  meat  to  be 
considered  in  connection  with  its  etiology. 

Coffee  and  tea  are  so  widely  and  almost 
universally  used  in  civilized  countries,  and 
their  apparently  pleasant  effect  is  so  great 


118   MEDICAL  ASPECTS  OF  CANCER 

that  few  realize  the  harm  that  may  result 
therefrom;  although  from  time  to  time 
their  injurious  effects,  especially  along  the 
line  of  digestive  and  nervous  troubles,  are 
dwelt  on  by  medical  writers.  Of  late 
years,  however,  more  attention  has  been 
paid  to  their  influence  on  metabolism  and 
also  to  the  relation  of  their  consumption 
to  the  increase  of  cancer.  From  a  report 
to  the  House  of  Commons  in  England, 
Holland  is  shown  to  be  the  largest  per 
capita  consumer  of  coffee  of  any  country 
in  Europe,  and  the  cancer  death  rate  there 
in  1905  was  among  the  highest,  while  Hun- 
gary was  the  smallest  consumer  of  coffee, 
and  the  cancer  mortality  in  1903  was  only 
39  per  100,000,  or  a  little  over  one-third 
that  in  Holland.  It  may  be  interesting  to 
know  that  Thompson  states  that  *'the  peo- 
ple of  the  United  States  consume  one-third 
of  the  total  coffee  produced,  or  more  than 
Germany,  Austria,  Hungary,  France  and 
the  United  Kingdom   combined.     On  the 


RELATION  OF  DIET  119 

other  hand  England  and  her  colonies  con- 
sume one-half  of  the  world's  output  of  tea, 
and  the  United  States  but  one-fifth  of 
it/' 

The  scientific  basis  of  a  possible  rela- 
tionship of  the  consumption  of  coffee  and 
tea  to  the  prevalence  of  cancer  may  be  bet- 
ter understood  when  we  remember  that 
caffeine  and  theine  belong  to  the  xanthin 
group,  and  contain  exactly  the  same  equiv- 
alent of  nitrogen  as  uric  acid.  A  single 
cup  of  coffee  of  fair  strength,  it  is  stated 
by  Hutchinson,  contains  from  one  to  three 
grains  of  caffeine,  and  a  cup  of  fairly 
strong  tea  1.21  grains,  or  more  than  the 
average  medicinal  dose  of  this  drug;  and 
all  know  how  great  may  be  the  consump- 
tion of  coffee  and  tea  by  some  individuals, 
and  that  many  of  the  working  class,  espe- 
cially, consume  enormous  amounts  of  tea, 
which  is  kept  brewing  all  day.  Roberts 
has  very  clearly  demonstrated,  by  clever 
experiments,     that    tea     interferes    very 


120   MEDICAL  ASPECTS  OF  CANCER 

greatly  with  both  the  salivary  and  gastric 
digestion. 

Alcohol,  or  some  of  its  combinations, 
has  also  been  shown  by  several  observers 
to  be  undoubtedly  an  element  contributory 
to  the  causation  of  cancer ;  this  relates  not 
only  to  countries  or  cities  where  the  con- 
sumption is  the  greatest  or  least,  but  also 
to  various  occupations,  in  which  statistics 
show  the  more  or  less  abundant  use  of  dis- 
tilled or  fermented  drinks,  and  deaths  from 
the  same,  and  in  regard  to  total  abstainers ; 
and  a  careful  study  of  the  subject  makes  it 
pretty  clear  that  the  incidence  of  cancer 
corresponds  in  a  measure  with  drinking 
habits;  that  is,  that  cancer  mortality  is 
highest  among  those  classes  of  persons 
among  whom  primary  or  secondary  mor- 
tality from  alcoholism  is  greatest.  There 
are  so  many  elements  to  be  taken  into  con- 
sideration in  connection  with  the  derange- 
ment of  metabolism  which  leads  to  can- 
cer, that  it  is  difficult  to  fix  the  precise 


RELATION  OF  DIET  121 

influence  which  each  may  exert;  but  in 
watching  cancer  cases  for  any  length  of 
time  it  is  easy  to  see  the  harmful  effect 
when  alcoholic  beverages  are  indulged  in, 
and  the  improvement  when  all  such  are 
absolutely  excluded. 

An  interesting  confirmation  of  the  bene- 
ficial results  of  a  low  diet  and  simple  life, 
as  regards  cancer,  is  found  in  certain  re- 
ports of  Commissioners  of  Prisons  and 
Asylums  in  England,  where  the  matter  has 
been  studied,  as  given  by  Russell.  ^^  Asy- 
lums contain  an  excessive  number  of  per- 
sons who  have  inherited  or  acquired  con- 
stitutional weaknesses,  and  in  many  cases 
tendencies  toward  consumption  or  cancer; 
also  many  alcoholics  who  are  prone  to 
these  maladies.  Yet  the  habits  and  rules 
of  these  institutions  reduce  the  cancer  rate 
much  below  the  rate  of  the  classes  from 
which  they  are  drawn,  and  below  the  rate 
of  both  occupied  and  unoccupied  persons. ' ' 
The  same  is  observed  in  regard  to  many 


122   MEDICAL  ASPECTS  OF  CANCER 

religious  orders,  where  the  members  lead 
a  very  simple  and  frugal  life,  and  where 
cancer  is  reported  to  be  almost  unknown. 

Kessler  has  called  attention  to  the  dis- 
turbance of  sulphur  partition  in  cancer 
in  connection  with  diet,  and  the  desirabil- 
ity of  excluding  those  foods  exhibiting  an 
excess  of  sulphur,  giving  lists  of  the  same 
and  indicating  a  satisfactory  diet. 

Packard  has  m-ade  a  strong  argument  in 
regard  to  the  value  and  importance  of  tlie 
mineral  elements  contained  in  plant  life, 
in  connection  with  the  disturbances  in 
these  same  elements  which  has  been  oh- 
served  in  connection  with  cancer,  as  we 
have  already  seen.  He  recalls  that  mod- 
ern chemistry  teaches  that  the  inorganic 
principles  of  the  vegetable  kingdom  are 
absolutely  necessary  to  the  highest  degree 
and  type  of  animal  tissue  and  health,  and 
resistance  to  disease.  Plant  life  is  the 
connection  between  the  minerals  and  salts 
of  the  earth  and  animal  life,  but  in  the 


RELATION  OF  DIET  123 

manufacture  or  refinement,  and  cooking, 
of   products    of    the    vegetable    kingdom, 
many  of  tliem  are  largely  demineralized ; 
this  especially  illustrated  in  the  case  of 
fine  white  wheat  flour,  rice,  potatoes   (in 
peeling  and  cooking),  etc.     So  that  while 
animals  get  plenty  of  mineral  matter  from 
plants  and  the  earth,  man  gets  but  little, 
and   while   the   herbivorous    animals    are 
rarely  affected  with  cancer,  civilized  man 
is  succumbing  to  it  more  and  more.     It  is 
stated  that  among  savage  tribes,  who  are 
practically  free  from  cancer,  the  water  in 
which  vegetables  are  cooked  is  also  con- 
sumed as  food,  thus  securing  all  the  salts. 
The   same   idea  has  been  popularly  pre- 
sented to  the  public  in  a  startling  manner 
by  McCann  in  a  book  which,  with  a  great 
deal  of  verbiage  contains  a  large  amount 
of  valuable  information  concerning  nutri- 
tion, and  its  disturbance  by  erroneous,  or 
worse,  preparation  and  administration  of 
food. 


124   MEDICAL  ASPECTS  OE  CANCER 

Possibly  tliere  are  other  dietary  ele- 
ments which  may  play  some  part  in  the 
causation  of  cancer,  but  the  demonstrated 
facts  in  regard  to  them  are  so  few  and  un- 
certain that  they  need  not  detain  us  here, 
although  it  is  certainly  desirable  to  inves- 
tigate any  that  seem  to  have  reasonable 
support. 

Some  of  these  which  have  been  sug- 
gested probably  have  to  do  with  local  irri- 
tant action  on  the  digestive  organs,  as  we 
have  previously  seen  that  local  irritation 
undoubtedly  plays  an  important  part  in 
the  determination  of  the  actual  time  of  oc- 
currence and  site  of  the  cancerous  disease. 
Thus,  some  have  ascribed  cancer  to  hot 
food  or  drink,  or  to  stimulating  drink,  con- 
diments, etc.  It  is  quite  possible  that 
these  contribute  to  the  development  of  can- 
cer in  the  pylorus,  irritating  the  secreting 
cells  in  their  passage.  Mayo  says:  *^In 
civilized  man  one-third  of  all  cancers  are 
seated  in  the  stomach.     This  is  not  known 


EELATION  OF  DIET  125 

to  be  the  case  in  uncivilized  man  or  in  ani- 
mals. There  should,  therefore,  be  some- 
thing— some  one  cause — ^which-  causes  this 
preponderance.  The  acid  secretion  may 
favor  its  development,  for  when  we  come 
to  the  colon,  also  with  an  acid  secretion, 
we  again  meet  with  cancer,  and  we  seldom 
see  it  in  the  alkaline,  small  intestine.  Gas- 
tric ulcer,  which  may  be  precancerous,  is 
coim.ected  with  hyperacidity. ' '  In  Scandi- 
navia cancer  of  the  stomach  is  remarkably 
frequent,  according  to  Soegaard,  thus,  of 
1235  cases  in  Norway,  73.9  per  cent  were 
in  that  location.  In  our  last  lecture  we 
found  that  cancer  in  general  was  connected 
with  a  lowered  alkalescence  of  the  blood, 
and  all  our  studies  show  hyperacidity  to 
be  related  to  cancer  genesis ;  and  nitrogen- 
ous acidity,  or  uric  acid  (purin,  xanthin, 
etc.),  undoubtedly  plays  a  great  part  in 
inducing  malignant  action  in  tissues,  as 
Haig  has  so  long  contended,  even  in  regard 
to  cancer. 


126   MEDICAL  ASPECTS  OE  CANCER 

The  increasing"  frequency  of  cancer  of 
the  mouth,  oesophagus,  and  stomach  in  men 
certainly  looks  toward  an  irritating  char- 
acter of  substances  which  traverse  these« 
regions,  including  alcoholic  drinks,  and  the 
irritant  effect  of  tobacco  should  not  be 
overlooked  in  regard  to  mouth  lesions. 
But  of  the  millions  who  use  tobacco  only 
very  few  are  affected  with  cancer,  and 
only  those  who  are  predisposed  thereto  by 
some  metabolic  disturbance,  whose  true 
character  and  other  manifestations  are  not 
yet  fully  determined.  We  have  already 
referred  to  the  practice  of  so-called  betel 
chewing  in  the  Far  East  as  a  frequent 
cause  of  cancer  within  the  mouth,  also  to 
the  wearing  of  the  Kangri  charcoal  baskets 
in  India,  for  warmth,  causing  a  burn  on  the 
front  of  the  body  which  may  develop  into 
epithelioma;  it  is  claimed,  however,  by 
by  some  that  of  the  many  cases  of  ^^  Kan- 
gri burn,''  but  few  result  in  epithelioma. 

There  are  yet  other  considerations  con- 


KELATION  OF  DIET  127 

cerning  the  relation  of  diet  to  cancer  which 
are  worthy  of  attention.  We  have  men- 
tioned some  principal  agents,  which  seem 
unquestionably  to  have  an  influence  in  the 
production  and  continuance  of  cancer, 
namely,  proteids,  cotfee  and  tea,  and  alco- 
holics. But  millions  of  human  beings  par- 
take of  these  with  apparent  impunity, 
while  in  the  relatively  few  they  appear  to 
have  cancer-genetic  powers.  This  need 
not  surprise  or  puzzle  us  any  more  than 
do  the  many  other  problems  in  medicine 
which  we  are  seeking  to  solve :  for  we  know 
how  often  it  happens  that  the  system 
reaches  a  point  where  certain  things,  once 
well  borne,  are  no  longer  tolerated.  We 
know,  for  instance,  that  Port  and  Madeira 
wine  certainly  can  cause  gout,  but  with 
many  individuals  they  may  be  indulged  in 
freely  for  some  time  before  this  result  fol- 
lows: likewise  that  tobacco  may  even  be 
abused  for  a  long  time,  without  apparent 
ill  effects,  when  suddenly  there  is  a  revul- 


128   MEDICAL  ASPECTS  OF  CANCER 

sion  of  the  system  and  tlie  slightest  use  of 
tobacco  will  be  intolerable :  also  that  many 
edible  substances  which  have  long  been 
well  borne,  will  at  a  certain  time  act  un- 
favorably and  excite  eruptions,  urticaria, 
acne,  eczema,  etc. 

Psoriasis  also  furnishes  an  illustration 
which  may  be  of  service  in  understanding 
the  relation  of  diet  to  cancer ;  for  psoriasis 
is  characterized  by  a  disordered  epithelial 
growth,  which  both  shows  on  the  surface 
and  manifests  itself  by  epithelial  prolonga- 
tions into  the  corium,  which  are  quite  com- 
parable to  the  ingrowing  cellular  masses 
of  early  cancer:  moreover  cancer  is  not 
very  rare  in  psoriasis  patients.  In  this 
eruption  it  has  been  very  clearly  demon- 
strated, clinically  and  experimentally,  that 
error  in  nitrogenous  metabolism  is  com- 
monly at  the  bottom  of  the  eruption,  which 
has  been  seen  to  promptly  disappear  en- 
tirely simply  under  an  absolute  vegetarian 
diet,   correctly   regulated,   excluding   also 


RELATION  OF  DIET  129 

coffee  and  alcohol,  without  the  use  of  any 
medical  treatment  whatever,  internal  or 
external;  but,  of  course,  this  result  cannot 
always  be  obtained,  and  sometimes  the 
eruption  will  relapse  during  what  is 
thought  to  be  a  strict  vegetarian  diet. 
There  must,  therefore,  be  some  systemic 
disturbance  which  causes  nutritive  mate- 
rial, at  some  ]3articular  time,  thus  to  de- 
range cell  action  in  the  eruptions  men- 
tioned, and  the  same  is  true  in  regard  to 
the  production  of  cancer. 

Some  years  ago  Braithwaite  called  atten- 
tion to  the  occurrence  of  cancer  among  cer- 
tain peoples  who  were  vegetarians,  and 
attributed  it  to  the  great  amount  of  salt 
which  they  consumed.  While  the  sugges- 
tion of  salt  being  a  cause  of  cancer  has 
been  ridiculed,  it  is  quite  possible  that  a 
great  excess  of  sodium  chloride  may  dis- 
turb the  salt  equilibrium  in  the  blood,  by 
replacing  the  potassium  which  is  so  neces- 
saiy  for  proper  cellular  nutrition,  and  also 


130  MEDICAL  ASPECTS  OE  CANCER 

by  hindering  the  excretion  of  uric  acid,  as 
Haig  has  pointed  out. 

When  we  inquire  into  the  cause  of  the 
systemic  disturbance  wliich  tends  to  such 
faulty  metabolism  that  the  nutrition  of 
cellular  structures  is  deranged,  even  to  the 
degree  of  taking  on  malignant  action,  we 
find  many  possible  elements,  more  or  less 
connected  with  what  is  known  as  modern 
civilization,  to  which  we  have  time  to  but 
briefly  allude.  Williams  has  shown  pretty 
clearly  that  wealth,  with  its  tendency  to 
luxury  and  idleness,  greatly  increased  the 
proclivity  to  cancer:  not  only  is  this  ob- 
served in  different  countries,  but  in  cer- 
tain cities  the  difference  is  very  striking 
between  the  cancer  mortality  in  sections 
which  are  occupied  by  the  rich  and  well- 
to-do,  and  those  in  which  the  poorer  classes 
are  herded.  Also  in  England  it  was  found 
in  one  decennium  that  cancer  mortality 
was  more  than  twice  as  great  among  the 
well-to-do  men,  having  no  specific  occupa- 


KELATION  OF  DIET  131 

tion,  as  among  occupied  males  in  general, 
the  ratio  being  96  to  44. 

Change  in  the  mode  of  life,  and  sudden 
changes  of  environment  have  also  been 
found  to  have  a  great  effect  in  the  produc- 
tion of  cancer,  as  has  already  been  men- 
tioned in  another  lecture. 

Finally,  for  our  time  does  not  permit  a 
fuller  discussion,  nervous  conditions  un- 
questionably can  and  very  often  do  exert 
a  profound  influence  on  the  secretion  of 
the  various  organs  of  the  body,  and  can 
so  disturb  digestion,  metabolism,  and  nu- 
trition that  the  most  varied  results  may 
follow,  to  which  the  names  of  different  dis- 
eases are  given;  so  that  nerve  strain,  more 
or  less  incident  to  modem  life,  must  be 
accredited  with  a  certain  share  of  influ- 
ence in  the  production  of  cancer.  The  part 
which  imperfect  and  deficient  intestinal 
and  urinary  excretion  play  in  inducing  or 
perpetuating  the  disease  will  be  treated  of 
in  later  lectures. 


132    MEDICAL  ASPECTS  OF  CANCER 

In  our  next  lecture  we  will  consider  cer- 
tain matters  relating  to  the  medical  treat- 
ment of  cancer,  but  from  long  experience 
and  study  I  am  firmly  convinced  that  such 
measures  are  of  relatively  little  service  un- 
less coupled  with  a  rigid  care  of  the  diet 
and  hygiene.  As  Bell  remarks,  ^'Cancer 
is  essentially  a  disease  supervening  upon 
a  persistent  neglect  of  hygienic  laws. '  ^  It 
is  a  disease  of  sub-oxidation,  and  all  the 
hygienic  elements  of  importance  in  tubercu- 
losis are  equally  necessary  in  cancer ;  fresh 
air  and  sunlight  with,  as  far  as  possible, 
an  ideal  regulation  of  life  in  all  its  aspects, 
are  indispensable. 

Inasmuch  as  there  is  no  specific  medical 
antidote  for  cancer,  and  we  cannot  be  cer- 
tain of  securing  at  once  the  metabolism  of 
health,  it  is  wise  to  remove  and  to  keep 
away  from  the  system  those  articles  which 
have  been  shown  to  have  more  or  less  influ- 
ence in  its  production,  namely,  animal  pro- 
teids,    coffee,    tea,    and    alcoholics.     Time 


EELATION  OF  DIET  133 

does  not  admit  a  discussion  of  vegetarian- 
ism, nor  is  it  necessary,  for  there  is  abun- 
dant evidence  in  literature  and  on  every 
side  that  perfect  health  can  be  maintained 
thereby,  and  I  went  over  the  subject  pretty 
thoroughly  two  years  ago.  The  vegetable 
kingdom  contains  protein  enough  to  build 
up  and  maintain  the  tissues  of  the  body,  as 
is  shown  in  animals,  and  an  extra  number 
of  calories  can  be  easily  obtained  from  but- 
ter, of  which  a  quarter  of  a  pound  contains 
some  800  calories,  or  fully  one-third  of  the 
total  daily  quantity  required  by  most  indi- 
viduals. The  details  of  a  purely  vege- 
tarian diet,  which  experience  has  shown 
to  be  of  the  greatest  value  in  cancer,  can 
be  worked  out  for  individual  cases  as  re- 
quired. I  am  also  firmly  convinced  that 
in  this  absolutely  vegetarian  diet,  with 
other  proper  hygienic  and  medicinal  meas- 
ures, to  be  detailed  next  week,  we  shall  find 
a  great  power  for  the  prevention  of  can- 
cer ;  although  many  persons  are  already  so 


134   MEDICAL  ASPECTS  OE  CANCER 

saturated  with  poisoned  blood  and  tissues 
from  prolonged  errors  of  life,  tliat  per- 
haps no  very  striking  general  effect  on  the 
community  can  be  obtained  therefrom  in 
this  generation. 

In  closing  this  lecture  I  must  again  urge 
upon  you  the  necessity  of  great  patience 
and  perseverance,  with  very  much  careful 
study  of  the  patient  in  all  particulars,  over 
a  great  length  of  time,  if  really  favorable 
results  are  to  be  obtained  in  cancer;  and 
this  is  true  whether  the  disease  be  incipi- 
ent, or  fully  developed,  or  even  post-oper- 
ative. The  causes  of  cancer  are  deep 
seated,  and,  as  with  many  chronic  affec- 
tions, there  is  no  tendency  to  continue  an 
improvement  once  begun,  but  under  a  re- 
turn to  the  same  conditions  as  before  the 
disease  will  certainly  assert  itself.  We 
have  learned  the  lesson  of  assiduous  perse- 
verance in  tuberculosis;  let  us  learn  it  in 
regard  to  cancer. 


LECTURE  V 

MEDICAL    TREATMENT    OF    CANCEE 

It  is  remarkable  that  so  little  serious  at- 
tention has  been  paid  to  the  medical  treat- 
ment of  cancer,  in  standard  works,  in  view 
of  the  occasional  strong  statements  and 
reports  which  have  appeared  from  time  to 
time  in  current  literature  and  in  occasional 
books,  dating  back  for  many  years.  Much 
of  this,  of  course,  relates  to  imperfect  ob- 
servation and  erroneous  diagnosis,  and 
also  to  crude  medical  knowledge,  but  there 
have  been  also  plenty  of  good  men,  who 
knew  the  disease  and  have  reported  favor- 
able results,  and  even  the  complete  dis- 
appearance of  cancer,  under  dietetic  regi- 
men and  proper  medication  alone,  without 
operative  interference  of  any  kind. 
Not  to  go  back  too  far,  reference  can  be 

135 


136   MEDICAL  ASPECTS  OF  CANCER 

made  to  Lambe,  who  one  hundred  years 
ago  wrote  clearly  in  regard  to  the  causa- 
tion of  cancer  from  luxurious  living,  and 
adduced  strong  proof  to  show  the  effect  of 
diet  in  curing  certain  cases  of  undoubted 
cancer  of  the  breast  and  uterus,  the  diag- 
nosis of  which  was  confirmed  by  prominent 
surgeons  of  the  day,  several  of  whom  en- 
dorsed the  vegetarian  diet.  Abernethy 
wrote  pointedly,  soon  after,  regarding  the 
constitutional  origin  of  tumors  and  says, 
^' There  can  be  no  subject  which  I  think 
more  likely  to  interest  the  mind  of  the  sur- 
geon, than  that  of  an  endeavor  to  amend 
and  alter  the  state  of  a  cancerous  constitu- 
tion. The  best  timed  and  best  conducted 
operation  brings  with  it  nothing  but  dis- 
grace, if  the  diseased  propensities  of  the 
constitution  are  active  and  powerful.  It 
is  after  an  operation  that,  in  my  opinion, 
we  are  most  particularly  incited  to  regulate 
the  constitution,  lest  the  disease  should  be 
revived  or  renewed  by  its  disturbance." 


TREATMENT  OF  CANCER      137 

He  then  gives  an  endorsement  of  Lambe's 
dietetic  treatment  of  cancer,  and  presents 
several  reasons  wliy  it  should  be  fairly 
tried. 

In  the  classical  work  of  Walshe  we  find 
numerous  references  to  the  constitutional 
nature  of  cancer,  original  or  quoted  from 
recognized  authorities,  as  well  as  expres- 
sions in  regard  to  the  futility  of  expecting 
that  surgical  interference  would  cure  the 
real  disease  in  any  great  proportion  of 
cases.  He  says,  "It  would  in  theory  ap- 
pear that  the  removal  of  a  tumor  cannot 
in  itself  cure  the  disease,  as  the  local  for- 
mation is  but  a  symptom  of  a  general  vice 
of  the  economy."  .  .  .  ''This  tissue  being, 
as  the  normal  textures,  the  seat  of  nutri- 
tion, is  like  them  susceptible  of  its  disor- 
dered actions,"  and  he  alludes  more  or  less 
to  the  effect  of  diet  on  the  disease. 

The  late  Willard  Parker,  one  of  New 
York's  gTeat  surgeons,  in  a  study  of  397 
cases  of  cancer  of  the  female  breast,  ob- 


138   MEDICAL  ASPECTS  OF  CANCER 

served  from  1830  to  1880,  wrote  very 
strongly  in  regard  to  tlie  constitutional  re- 
lations of  cancer.  In  considering  the  eti- 
ology lie  places  constitutional  causes  first, 
and  says,  *  luxurious  living,  and  particu- 
larly excess  in  animal  food,  increases  the 
waste  products  of  the  body,  and  if  coupled 
with  insufficient  exercise,  the  waste  prod- 
ucts are  retained  in  the  system  and  have  a 
tendency  to  produce  abnormal  growths.'' 
.  .  .  ^'Cancer  is  to  a  great  degree  one  of 
the  final  results  of  a  long-continued  course 
of  error  in  diet,  and  a  strict  dietetic  regi- 
men is,  therefore,  a  chief  factor  in  the 
treatment,  preventative  and  curative.'' 
Concluding  his  study  he  says,  ^' There  is 
such  a  consensus  of  opinion  as  to  the  ad- 
visability of  early  removal  of  the  growth, 
that  a  discussion  of  the  subject  would  be 
useless.  So  then,  in  the  first  place,  let  us 
remove  the  tumor,  and  thoroughly.  But 
after  we  have  done  so,  after  we  have  taken 
it  out  by  the  very  roots,  is  this  sufficient! 


TREATMENT  OF  CANCER      139 

No.  We  must  then  adopt  the  means  stated 
above  to  prevent  a  second  development. 
We  must  change  the  diathesis;  we  must 
seek  to  modify  the  patient's  constitution 
so  that  it  will  be  no  longer  prone  to  repro- 
duce the  disease:  and  then  only  may  the 
surgeon  be  satisfied  that  he  has  done  his 
duty."  He  further  says,  ^'In  regard  to 
the  effect  of  abstemiousness  on  cancer  I 
can  speak  with  great  positiveness,  that 
vegetable,  or  at  least  a  very  bland  diet, 
does  check  the  progress  of  the  disease,  and, 
in  some  cases  now  under  treatment,  has 
been  attended  by  an  alleviation  of  symp- 
toms ;  and  in  a  few  instances  even  by  a  re- 
cession of  the  growth."  He  also  quotes 
from  Sir  Astley  Cooper  some  strong  lan- 
guage which,  as  he  says,  ^' shows  a  broader 
and  more  enlightened  view  of  the  subject 
than  is  contained  in  the  writings  of  some 
more  recent  observers,  who  have  supposed 
that  they  were  working  far  in  advance  of 
the  great  English  surgeon";  the  rather 


140   MEDICAL  ASPECTS  OF  CANCER 

long  quotation  then  given  proves  that  that 
great  surgeon  also  believed  absolutely  in 
the  constitutional  nature  of  cancer. 

Sir  James  Paget  is  often  mentioned  by 
writers,  sometimes  even  with  derision,  as 
a  believer  in  the  Constitutional  Nature  of 
Cancer,  and  his  words  are  very  strong; 
says  he,  ^^I  believe  it  to  be  constitutional, 
in  the  sense  of  having  its  origin  and  chief 
support  in  the  blood,  by  which  the  consti- 
tution of  the  whole  body  is  maintained," 
and  speaks  at  some  length  in  his  lecture, 
in  support  of  this  view;  I  will  give  you 
one  other  small  quotation.  ^ '  The  existence 
of  the  morbid  material  in  the  blood, 
whether  in  the  rudimental  or  in  the  effec- 
tive state,  constitutes  the  general  predispo- 
sition to  cancer,''  etc.  It  is  remarkable 
that  the  views  of  this  prince  of  surgeons 
and  pathologists  should  not  have  carried 
more  weight  in  regard  to  cancer,  when  his 
other  views  are  so  well  accepted. 

Time  does  not  permit  us  even  to  refer 


TREATMENT  OF  CANCEE      141 

to  the  great  mass  of  more  or  less  similar 
views  and  corroborative  evidence  scattered 
in  books  and  current  literature  during  the 
last  fifty  years,  but  a  few  more  references 
may  be  given.  In  1884,  and  again  lately, 
Merriam  has  called  attention  to  cancer  oc- 
curring as  a  reversion  of  tissue  cells  to 
earlier  or  embryonic  forms  under  the  influ- 
ence of  a  disordered,  or  as  he  calls  it,  a 
poisoned  blood  stream,  from  over  nutri- 
tion from  a  meat  diet;  and  Haig  has  long 
maintained  that  uric  acid  is  a  prominent 
factor  in  the  etiology  of  cancer. 

While  few  will  agree  with  Haig  in  all  his 
conclusions,  there  is  no  doubt  but  that  a 
faulty  nitrogenous  m-etabolism  plays  a  not 
inconsiderable  part  in  the  causation  of 
many  diseased  conditions,  as  has  been  also 
sho'^n  in  a  previous  lecture  to  be  true  in  re- 
gard to  cancer :  and  while  it  may  not  be  ac- 
tually uric  acid  or  urea  which  does  the 
harm,  as  these  are  relatively  harmless  end 
products  of  metabolism,  it  is  true  that  the 


142    MEDICAL  ASPECTS  OF  CANCER 

purin  and  xanthin  bases,  of  many  forms, 
and  imperfectly  oxidized  nitrogenous  ele- 
ments, are  active  agents  in  the  production 
of  disease.  Venus  and  Isenberg  have  both 
written  very  strongly  in  regard  to  the  un- 
questioned value  of  a  vegetarian  diet  in 
cancer,  the  former  citing  many  supporters 
of  the  view,  from  ancient  times  to  the  pres- 
ent. If  time  permitted  any  amount  more 
of  corroborative  evidence  could  be  given 
in  regard  to  the  connection  of  cancer  with 
metabolic  disorders. 

There  have  been  many  scattered  articles 
concerning  the  chemico-pathology  of  can- 
cer, all  looking  in  much  the  same  direction 
as  that  which  we  are  pursuing,  which  can- 
not even  be  alluded  to,  but  brief  mention 
must  be  made  of  a  most  illuminating  and 
suggestive  study  by  Bristol.  Eeviewing 
the  many  theories  of  the  etiology  of  neo- 
plasms he  shows  pretty  clearly  that  cell 
reproduction  comes  from  outside  the  cell, 
or  from  the  surrounding  cell  medium  by  a 


TKEATMENT  OF  CANCER      143 

process  of  diffusion,  or  by  a  definite  chem- 
ical attraction,  and  is  closely  associated 
with  the  nutrition  and  growth  of  the  cell, 
especially  the  nucleus;  also  that  a  fixed 
ratio  between  the  salts  in  the  blood,  lymph, 
and  tissues  is  necessary  for  normal  activ- 
ity and  reproduction  of  cells ;  further  that 
a  disturbance  in  this  ratio  and  an  upset  in 
the  chemical  equilibrium  will  lead  to  abnor- 
mal metabolism,  growth,  and  reproduction, 
and  result  in  an  atypical  growth  in  the 
local  area  involved. 

As  before  remarked,  it  seems  strange 
that  the  medical  profession  and  the  public 
have  been  so  slow  in  accepting  the  views 
here  presented.  But  both  have  become  so 
obsessed  with  the  idea  that  nothing  can 
be  done  for  cancer  except  operative  pro- 
cedure of  some  kind,  and  so  dazzled  with 
the  glamour  of  modern  surgery,  so  fasci- 
nated with  the  apparent  definiteness  of 
laboratory  proceedings,  and  so  attracted 
by  the  glory  of  purely  scientific  research, 


144   MEDICAL  ASPECTS  OF  CANCER 

that  it  is  very  difficult  for  any  other  doc- 
trines to  make  headway:  moreover,  any 
dietary  or  medical  treatment,  prophylactic 
or  curative,  is  very  tedious  and  also  diffi- 
cult, in  the  way  of  attention  to  minute  de- 
tails-, etc.,  and  patients  weary  of  restric- 
tions and  are  restless  at  seeing  little  or 
slow  progress  made.  Haig  found  the  same 
difficulty  with  Hospital  patients,  but  does 
not  hesitate  to  state,  that  in  private  prac- 
tice *^some  undoubted  cases  of  cancer  have 
gotten  well''  under  his  dietary  restrictions. 
But  when  it  is  remembered  that  it  is  cal- 
culated that,  under  present  existing  condi- 
tions and  treatment,  fully  90  per  cent,  of 
those  attacked  with  cancer  ultimately  die 
from  it,  and  that  there  were  last  year 
nearly  50,000  recorded  deaths  from  this 
cause  in  the  ^'Registration  area''  of  the 
United  States,  covering  but  two-thirds  of 
its  population,  and  that  the  disease  is  rap- 
idly and  surely  increasing,  it  behooves  the 
Medical  Profession  to  put  forth  the  best 


TREATMENT  OF  CANCER      145 

efforts  possible  to  stay  the  progress  of  the 
disease.  In  New  York  City,  according  to 
the  Weekly  Bulletins  of  the  Board  of 
Health,  there  were  from  May  to  Novem- 
ber, 1914,  in  26  weeks,  2173  deaths  from 
Cancer,  Malignant  Tumor,  or  an  average 
of  83.5  per  week,  almost  twelve  deaths 
daily  from  malignant  disease. 

Operative  surgery  has  unquestionably 
been  of  great  service  in  certain  cases  and 
along  certain  Hues  of  cancer,  and  the  claim 
for  the  earliest  possible  removal  of  morbid 
growths  is  certainly  a  just  and  proper  one ; 
moreover,  with  our  present  knowledge  it 
is  perhaps  wise  to  attempt  to  remove  the 
offending  mass  while  there  is  some  hope  or 
prospect  of  benefit,  and  personally  I  am 
occasionally  advising  this  in  proper  cases. 
X-ray  and  radium  have  also  their  sphere 
of  usefulness  in  a  certain  class  or  group  of 
cases,  but  the  excessive  exploitation  of  the 
latter,  not  long  ago,  did  harm  in  raising 
false  hopes  in  multitudes  of  sufferers,  and 


146   MEDICAL  ASPECTS  OF  CANCER 

as  these  were  shattered  so  also  was  confi- 
dence shaken  in  regard  to  all  help  for  can- 
cer from  other  than  surgical  removal. 

But  every  one  who  has  been  brought 
much  into  contact  with  cancer  knows  full 
well  what  a  mass  of  recurrent  cases  exist, 
possibly  many  of  them  due  to  bad  oper- 
ation, in  regard  to  which  surgery  has  to 
acknowledge  that  it  can  offer  nothing  more, 
that  they  are  inoperable  and  therefore 
they  are  regarded  as  incurable.  Every 
one  also  knows  how  many  cases  there  are 
which  have  advanced  so  far  before  coming 
to  a  competent  surgeon,  that  they  are  also 
inoperable.  Every  one  likewise  knows  that 
there  are  numerous  cases  of  cancer  in  in- 
ternal regions,  and  in  certain  localities,  and 
presenting  peculiar  features,  which  are  also 
recognized  as  inoperable,  at  least  with  any 
proper  justification.  Thus  it  may  safely 
be  said  that  of  the  total  number  of  cases 
of  cancer  existing  at  any  one  time,  which 
would  be  included  under  the  above  classes. 


TREATMENT  OF  CANCER      147 

fully  50  per  cent,  are  sucli  that  operative 
surgery  can  offer  no  hope  of  material  bene- 
fit :  also,  it  must  be  acknowledged  that  but 
a  relatively  small  proportion  of  all  cancer 
cases  are  likely  to  secure  the  very  best 
surgical  service,  such  as  claims  the  highest 
percentage  of  success. 

For  this  large  number  of  hopeless  vic- 
tims of  this  dire  disease,  at  least,  proper 
dietary  and  medical  treatment  should  be 
most  carefully  studied  and  patiently  ap- 
plied, with  the  hope  and  expectation  that 
the  same,  if  correctly  employed,  would 
more  or  less  hinder  or  check  its  progress 
or  prevent  a  recurrence  after  operation. 
But  experience  shows  that  such  measures, 
if  taken  promptly  and  thoroughly,  can  also 
prevent  the  development  of  early  threaten- 
ing lesions  into  those  of  malignant  charac- 
ter, suggesting  surgical  removal,  and  these 
should  never  be  neglected  when  there  is 
the  slightest  suspicion  of  cancer.  For  it 
must  be  acknowledged  that  the  surgery  of 


148   MEDICAL  ASPECTS  OF  CANCER 

cancer  is  only  an  attempt  at  the  physical 
removal  of  a  something,  which  medical 
science  and  art  should  not  have  allowed  to 
develop  out  of  normal  tissue.  And  in  the 
matter  of  the  general  prophylaxis  of  can- 
cer it  is  certainly  worth  while  to  consider 
and  act  strongly  upon  the  facts  which  have 
been  presented,  especially  in  those  indi- 
viduals who  have  any  hereditary  suspi- 
cions, or  who  exhibit  the  habit  of  body  or 
life  which  could  lead  to  the  development  of 
cancer. 

The  medical  care  of  cancer,  as  of  all  dis- 
eases, naturally  includes  both  prophylaxis 
and  the  treatment  of  a  morbid  condition 
which  has  already  developed ;  the  former  of 
these  is  always  considered  to  be  of  the 
highest  importance. 

Prophylaxis  of  Cancer.  From  what  has 
preceded  in  this  and  other  lectures  it  can 
readily  be  understood  that  the  prevention 
of  cancer  lies  largely  along  dietary  and  hy- 
gienic lines,  including  such  medical  atten- 


TREATMENT  OF  CANCER      149 

tion  as  shall  secure  healthy  action  of  the 
secreting  and  excreting  organs.  If  the  fig- 
ures and  facts  heretofore  given  are  correct, 
if  cancer  has  surely  been  observed  to  in- 
crease under  certain  conditions  of  life,  if  it 
is  found  to  be  absent  or  relatively  rare 
under  certain  other  conditions  of  living,  if 
cancer  has  been  known  to  disappear  spon- 
taneously in  certain  individuals,  especially 
when  they  have  changed  their  mode  of  liv- 
ing, it  must  then  follow  that  when  the  ex- 
actly correct  habit  and  state  of  hf  e  are  con- 
tinually assumed  the  disease  will  not  oc- 
cur. 

In  other  words,  when  the  blood  stream 
nourishing  the  tissues  is  ideally  correct, 
the  individual  cells  of  the  body  perform 
their  functions  normally,  and  as  each  cell 
is  worn  out  it  is  removed  by  a  healthy  cat- 
abolism  and  renewed  by  a  normal  anabo- 
lism,  and  homologous  cells  then  replace 
those  which  have  ceased  to  be  able  to  per- 
form their  function.     On  the  other  hand. 


150   MEDICAL  ASPECTS  OF  CANCEE 

wlien  there  is  perverted  metabolism  we 
have  various  forms  of  deranged  action,  to 
which  we  give  the  names  of  various  dis- 
eases, one  of  which  is  cancer :  here  in  place 
of  homologous  cells  maintaining  the  tissues 
in  a  normal  condition,  we  have  a  malignant 
metamorphosis  into  heterologous  cells, 
which  take  on  a  disorderly  or  rampant  ac- 
tion, and  refuse  to  assimilate  themselves  to 
others,  so  as  to  form  healthy  tissue;  we 
have  then  a  mass  of  low  vitality,  tending 
to  easily  break  down  or  ulcerate,  and  to 
extend  their  malignant  action  to  adjoining 
tissues,  under  the  continued  influence  of  a 
contaminated  blood  current.  When  once 
ulceration  has  occurred,  the  ordinary  para- 
sitic micro-organisms,  which  are  prac- 
tically omnipresent,  find  an  acceptable 
nidus,  and  aid  in  the  destructive  work,  and 
also  in  the  systemic  poisoning  of  the  tis- 
sues. 

The  aim,  then  to  be  sought  in  the  pro- 
phylaxis of  cancer  is  to  secure  the  most 


TREATMENT  OF  CANCER      151 

perfect  blood  stream  possible,  wbicb  is  ac- 
complished by  simple  living,  perfect  masti- 
cation, and  the  avoidance  of  excesses,  espe- 
cially along  the  lines  of  protein,  tea  and 
coffee,  alcohol,  etc.,  with  the  maintenance 
of  healthy  habits  of  life,  especially  in  re- 
gard to  bowel  action.  As  already  inti- 
mated, we  do  not  know  just  why  in  some 
persons  and  at  a  certain  time  a  disturbance 
of  metabolism  results  in  perverted  cell 
growth,  but  there  is,  of  course,  a  reason, 
and  the  physician's  duty  is  so  to  regulate 
the  patient's  whole  life  that  the  metabolism 
is  kept  in  the  state  of  perfect  health.  All 
this  seems  very  simple  and  trite,  but  really 
it  is  a  task  which  is  most  important  and 
often  most  difficult  to  accomplish,  and  re- 
quires very  careful  study  and  infinite  pa- 
tience. Dr.  Kellogg,  of  Battle  Creek,  says 
that  of  the  many  thousands  who  have 
passed  under  his  care  he  has  not  known 
cancer  to  develop  in  any  one  who  had  been 
faithful  to  the  principles  which  he  incul- 


152   MEDICAL  ASPECTS  OF  CANCER 

cates,  and  I  may  say  the  same  of  the  many 
who  have  been  under  my  care  in  private 
practice,  often  with  notes  extending  over 
many  years. 

Time  does  not  permit  of  going  into  de- 
tail here  in  regard  to  the  special  features 
of  diet  and  hygiene,  which  I  discussed  with 
you  fully  two  years  ago,  in  my  lectures, 
which  were  subsequently  published :  suffice 
it  to  say,  as  previously  remarked,  that  the 
refinements  of  civilization  add  greatly  to 
the  temptation  of  over-eating,  and  wrong 
eating  and  drinking,  as  they  do  to  numer- 
ous other  temptations,  and  in  many  in- 
stances it  requires  the  utmost  amount  of 
grit  as  well  as  patience,  both  in  the  pa- 
tient and  doctor,  to  secure  the  perfect  re- 
sult necessary. 

It  is  understood,  I  trust,  that  I  believe 
that  for  the  proper  treatment  of  cancer, 
and  to  prevent  its  occurrence  and  recur- 
rence, it  is  absolutely  necessary  to  main- 
tain a  perfect  vegetarian  diet,  which  in- 


TREATMENT  OF  CANCER      153 

eludes  even  the  exclusion  of  eggs  and  milk, 
with  food ;  but  the  yolk  of  eggs  may  some- 
times be  taken  with  advantage,  and  also 
milk  alone  and  separate,  at  a  body  tempera- 
ture, one  hour  before  eating,  according  to 
the  plan  which  I  have  often  demonstrated 
to  you.    As  remarked  in  my  last  lecture, 
the  vegetable  kingdom  contains  proteid  suf- 
ficient for  the  system,  and  the  diet  should 
be  so  arranged  as  to  give  the  requisite 
quantity  of  calories,  in  proper  proportion, 
of  vegetable  protein,  carbohydrates,  and 
fats:   the   latter  is   accomplished   largely 
with  butter,  of  which  a  quarter  of  a  pound 
may  be  taken  daily.     Many  writers  on  diet 
hold  that  the  protein  in  casein  acts  differ- 
ently from  that  contained  in  meat,  and  this 
is  allowed  in  many  vegetarian  dietaries :  it 
also  contains  phosphorus,  which  is  an  inte- 
gral part  of  living  cells,  especially  their 
nuclei.    When  nutrition  seems  to  demand 
it,  this  can,  perhaps,  be  added  to  the  diet, 
mixed  with  cereals  or  in  soups,  and  a  small 


154   MEDICAL  ASPECTS  OF  CANCER 

amount  of  certain  kinds  of  cheese  is  also 
sometimes  allowable.  It  is  impossible  to 
elaborate  the  details  of  diet  fully  in  a  lec- 
ture such  as  this,  and  I  must  refer  you  to 
the  many  excellent  works  on  food  and  nu- 
trition (Hutchinson,  Sherman,  Thompson, 
Buttner,  Braithwaite),  for  further  infor- 
mation. 

The  medical  treatment  of  cancer  pa- 
tients is  a  matter  which  should  receive 
most  careful  and  constant  attention;  in- 
deed, the  patient  in  whom  cancer  is  threat- 
ening or  has  developed  should  be  under  the 
watchful  and  unremitting  guidance  of  a 
physician  who  grasps  the  importance  of 
the  matter  and  is  prepared  to  guard  the 
health,  and  to  meet  and  correct  functional 
disorders  as  they  arise ;  for  a  careful  study 
of  patients  with  cancer  for  many  years  has 
constantly  shown  me  gross  errors  in  their 
life  and  in  the  action  of  various  organs, 
and  consequently  disorders  of  metabolism 


TREATMENT  OF  CANCER      155 

wMcli  are  of  weight  in  connection  with  the 
disease. 

The  first  point  of  importance  to  which 
I  wish  to  call  your  attention  is  in  regard  to 
the  action  of  the  bowels.  Some  of  you  may 
remember  that  even  that  great  surgeon, 
Sir  Arbtithnot  Lane,  has  recently  empha- 
sized the  fact  that  one  of  the  terminal 
results  of  intestinal  stasis  may  be  cancer. 
This  may  seem  strange,  but  it  would  sur- 
prise you  if  you  knew  how  very  commonly 
there  was  imperfect  intestinal  excretion,  or 
intestinal  stasis,  as  it  is  now  called,  in  these 
subjects ;  indeed,  I  might  almost  say  that  it 
is  the  rule,  and  that  this  assuredly  plays  a 
most  important  part  in  the  auto-intoxica- 
tion which  leads  up  to  cancer ;  in  fact,  I  al- 
most feel  like  saying  that  the  toxins  pro- 
duced by  the  millions  of  micro-organisms 
generated  through  intestinal  stasis  and  fe- 
cal putrefaction  are  the  real,  incidental 
cause  of  cancer.    Under  a  perfect  vegeta- 


156   MEDICAL  ASPECTS  OF  CANCER 

rian  diet  there  is  less  likelihood  of  trouble 
in  this  direction,  bnt  even  then  there  is  ne- 
cessity of  watching  continually,  that  there 
may  be  at  least,  one,  full,  free  movement 
of  normal  character,  daily,  after  break- 
fast. In  many  cancer  patients  I  have  se- 
cured this  by  having  the  entire  potato 
eaten,  skin  and  all,  whether  boiled  or 
baked ;  by  this  means  also  one  gets  the  full 
value  of  the  inner  layer  of  skin,  which  con- 
tains the  mineral  salts  so  necessary  to  the 
economy,  which  are  entirely  lost  when  the 
potatoes  are  peeled  before  boiling ;  so  that 
potatoes  should  always  be  cooked  in  their 
skins,  even  if  the  outer  layer  is  stripped 
off  afterwards. 

But  the  regulation  of  the  bowel  action 
should  not  be  left  to  the  judgment  and  ac- 
tion of  patients,  with  a  spasmodic  use  of 
remedies,  and  with  alternate  constipation 
and  purgation;  the  physician  himself 
should  carefully  guide  and  direct  the 
proper  treatment  frequently  enough  to  se- 


TREATMENT  OF  CANCER      157 

cure  perfect  results.  Of  course  eacli  one 
may  have  tlieir  own  ideas  and  methods,  but 
I  have  long  used  with  the  best  results  the 
remedies  which  you  have  often  heard  me 
order  in  this  clinic.  Thus,  at  the  begin- 
ning of  treatment,  and  often  on  the  same 
days  of  many  succeeding  weeks,  I  give  ^ 
Ext.  Colocynth.  Co.,  Mass  Hydrarg  aa  gr. 
X  Pulv.  Ipecac  gr.  ij  M.  Div.  in  Capsules 
No.  IV.  Sig.  Take  two  at  night  and  two 
on  the  second  night  after.  For  continuous 
use,  or  in  the  nights  between  these,  I  have 
long  used  a  compound  Cascarin  tablet  ( ^ 
Podophylin,  Aloin,  Cascarin  aa  gr.  %)  one 
or  more  each  night,  or  have  depended  on 
the  Cascara  in  a  mixture  of  which  I  shall 
shortly  speak.  I  do  not  like  the  action  of 
salts  or  laxative  mineral  waters  in  these 
cases,  and,  of  course,  enemata  are  entirely 
useless  to  secure  real,  effective  liver  and 
intestinal  action,  and  should  be  used  only 
in  an  emergency. 

The  action  of  the  kidneys  is  also  always 


158   MEDICAL  ASPECTS  OF  CANCER 

a  very  important  element  to  watch  and 
control  in  cancer  j)atients;  this  does  not 
have  reference  to  albumen  and  casts,  or 
glycosuria,  but  to  a  functional  derange- 
ment of  the  secretion:  for  the  former  are 
relatively  infrequent  compared  to  the  lat- 
ter. This  is  so  large  a  subject  that  time 
does  not  permit  of  its  elaboration;  I  made 
the  matter  pretty  clear  to  you  in  my  lec- 
tures not  long  ago  on  the  relations  of  dis- 
eases of  the  skin  to  internal  disorders.  I 
must  tell  you,  however,  that,  as  a  result  of 
numberless  studies  of  the  urine  of  many 
cancer  patients,  I  have  almost  constantly 
found  a  deficient  or  defective  urinary  se- 
cretion :  in  many  cases  I  have  had  the  total 
daily  amount  accurately  measured,  and  re- 
ported in  writing  each  week  over  long 
periods,  and  while  the  total  quantity  may 
at  times  be  near  normal,  the  total  solids 
sometimes  fall  to,  and  remain  at,  even  less 
than  one-half  the  amount  which  should  be 
passed  for  the  patient's  body  weight. 


TREATMENT  OF  CANCER      159 

I  want  here  to  urge  upon  you  the  impor- 
tance and  value  of  rei^eated  volumetric 
examination  of  all  possible  ingredients  of 
the  urine,  as  indicating  in  the  best  manner 
obtainable  the  state  of  the  arterial  blood, 
from  which  the  urine  is  derived :  especially 
is  this  true  of  the  exact  volumetric  acid- 
ity, representing  the  diminished  alkales- 
cence of  the  blood  common  in  cancer. 

The  actual  medicinal  and  dietary  treat- 
ment of  the  various  possible  departures 
from  normal  can  hardly  be  elaborated  here, 
but  they  are  along  very  much  the  same 
lines  which  you  have  often  watched  in  con- 
nection with  certain  diseases  of  the  skin; 
for  you  must  remember  that  carcinoma  is 
an  epithelial  disease,  and  that  the  laws  of 
nutrition  are  much  the  same  for  this  as  for 
various  other  morbid  conditions  of  the 
economy.  I  may  say,  however,  that  very 
many  of  my  cancer  patients  have  received 
the  greatest  benefit  from  acetate  of  potassa, 
often  in  the  formula  familiar  to  you   (^ 


160   MEDICAL  ASPECTS  OF  CANCER 

Potass.  Acetatis  gi  Tinct.  Nucis  Vomic  oiv 
Extr.  Cascar.  fld.  oij-oiv  Extr.  Rumicis 
radicis  fld.  ad  qIY  M.  Sig.  One  teaspoon- 
ful  half  an  hour  before  eating,  well  di- 
luted). For  many  years  I  have  adminis- 
tered potassa  largely  to  these  patients,  and 
it  is  gratifying  to  find  not  only  support  but 
an  incentive  to  its  greater  use,  in  the 
studies  and  experience  of  Ross,  who  pushes 
it  to  a  very  great  extent,  giving  as  high  as 
240  grains  of  potassium  phosphate  in  a 
day.  Ross  also  advises  the  free  use  of 
crude  or  brown  sugar,  as  it  contains  a  large 
proportion  of  potassium  salts,  which  are 
for  the  most  part  removed  from  the  white 
or  refined  article.  I  must  also  remind  you 
of  the  great  value  of  Bethesda  water,  in 
washing  out  the  kidneys,  given  a  tumbler- 
ful with  each  meal,  and  one  tumblerful,  hot, 
one  hour  before  breakfast  and  also  an  hour 
before  the  evening  meal. 

The  blood  should  also  be  watched,  and  in 
my  hospital  cases  I  have  a  count  made 


TREATMENT  OF  CANCER      161 

every  week;  for  the  liaemogiobin  content, 
and  the  number  of  the  erythrocytes,  and 
the  percentage  of  the  varieties  of  leucocytes 
afford  very  valuable  information  as  to  the 
physical  state  of  the  patient,  and  the  prog- 
ress or  recession  of  the  cancer,  and  in  a 
measure  these  data  are  of  value  in  direct- 
ing therapy.  I  have  also  the  iveigM  of  the 
patient  taken  and  recorded  each  week,  as  a 
guide  to  nutrition  and  dietary  matters. 
Also  the  saliva  is  tested  and  recorded  be- 
fore and  after  each  meal,  and  furnishes  an 
indication  in  regard  to  the  administration 
of  alkalies. 

Iron  is  found  to  be  greatly  wanting  in 
the  blood  and  tissues  late  in  cancer,  and 
should  always  be  an  element  in  the  treat- 
ment of  this  disease.  Skene  Keith,  notic- 
ing that  after  a  cancerous  mass  was  re- 
moved the  blood  recovered  in  regard  to 
hsemogiobin  and  erythrocytes,  administered 
iron  with  arsenic,  with  the  greatest  benefit, 
the  growth  shriveling  up  and  the  patient 


162    MEDICAL  ASPECTS  OF  CANCER 

gaming  in  weight;  lie  recommends  tlie 
citrate  of  iron  and  ammonia,  the  prepara- 
tion which  I  have  given  to  patients  for 
many  years  past.  He  also  advises  hypo- 
dermic injections  of  iron,  arsenic,  and  soda, 
and  reports  cases  thus  treated,  some  of 
them  with  good  results.  There  is  a  loss  of 
phosphates  in  these  patients,  and  phos- 
phate of  iron  or  other  phosphates  are  valu- 
able. 

When  considering  the  metabolism  of  can- 
cer mention  was  made  of  derangement  in 
the  action  of  the  ductless  glands  in  this 
disease,  and  of  the  use  and  value  of  certain 
preparations  of  the  internal  secretions  in 
its  treatment.  While  a  hormone  therapy 
of  cancer  is  still  in  its  infancy,  in  spite  of 
many  books  and  innumerable  journal  arti- 
cles on  the  internal  secretions,  it  is  quite 
possible  that  the  future  may  demonstrate 
its  efficacy  in  helping  to  control  the  dis- 
ease :  for,  that  the  latter  are  efficient  agents 
in  carrying  on  the  vital  processes  in  the 


TREATMENT  OF  CAXCER      163 

body,  there  can  be  no  question,  although  as 
Biedl  remarks,  ''Our  knowledge  of  the 
chemistrv  of  hormone  formation  is  verv 
slight." 

But  considerable  clinical  evidence  has 
been  accumulated  that  one  at  least  of  the 
internal  secretions,  namely,  that  of  the 
till/ raid,  has  a  definite  beneficial  effect 
upon  cancer;  this  I  have  administered  to 
many  cancer  patients,  and  have  reason  to 
believe  that  it  contributed  to  the  favorable 
results  obtained.  Sajous,  believing  that 
insufficiency  of  the  adrenal  secretion  is  an 
element  in  altered  nutrition,  advocates 
thvroid  extract  on  the  sTOund  that  it  stimu- 
lates  the  activity  of  the  adrenals :  Vincent 
quotes  Erlich  as  belie^-ing  that  "there  may 
be  substances  circulating  in  the  organism 
which  may  stimulate  the  body  cells  to  re- 
sist the  athreptic  influence  of  cancer  cells." 
Shirlaw  advises  a  tablet  made  of  thyroid 
6  grains,  supra-renal  %  gTain,  and  pitui- 
tary Ke  grain.     ^Vhile  the  treatment  by 


164   MEDICAL  ASPECTS  OF  CANCER 

these  hormones  from  internal  secretions  is 
really  in  rather  an  experimental  stage,  it 
would  seem  more  than  probable  that  the 
correct  use  of  these  pluriglandular  ex- 
tracts, in  combination  with  other  proper 
dietary  and  medicinal  treatment,  would  be 
of  service  in  the  prophylaxis  and  treatment 
of  cancer.  I  have  been  a  little  cautious  in 
the  use  of  thyroid,  beginning  with  two  or 
three  grains  with  meals,  three  times  daily; 
for,  as  a  promoter  of  catabolism  it  can  dis- 
integrate tissue  faster  than  the  emunctories 
can  remove  the  effete  products,  and  may 
thus  poison  the  system. 

Serum-  and  Vaccine-therapy  are  yet  in 
a  stage  of  development,  and  as  I  have  had 
little  or  no  personal  experience  with  them 
I  will  not  attempt  to  discuss  their  value, 
which  time  alone  will  demonstrate.  While 
there  have  been  many  claims  of  success 
from  treatment  along  these  lines,  unfor- 
tunately they  have  not  been  confirmed  by 
later  observations  by  others:  I  may  say 


TREATMENT  OF  CANCER      165 

frankly  that  they  have  never  appealed  to 
me  as  rational,  in  consideration  of  the 
views  and  experience  I  have  long  had  along 
other  lines  of  thought  and  practice.  If, 
however,  future  investigations  shall  con- 
firm some  of  the  remarkable  reports  which 
have  been  made,  the  latest  of  which  is  by 
Nowell,  there  may  be  opened  a  non-surgical 
line  of  treatment  of  cancer  which  would 
mean  much  to  many  otherwise  hopeless 
cases. 

The  local  medical  treatment  of  cancer  is 
also  an  important  matter  which  should  re- 
ceive careful  attention.  For  many  years 
in  early  cancer  of  the  breast,  under  proper, 
general,  dietetic,  hygienic,  and  medicinal 
treatment,  I  have  seen  the  lump  vanish 
under  the  continued  application  of  the 
iodide  of  lead,  in  Hebra's  diachylon  oint- 
ment of  the  German  Pharmacopoeia 
(3ss-5i  ad  gi),  and  in  very  many  instances 
I  have  had  the  assurance  of  patients  that 
its  application  relieved  the  pain  and  was 


166   MEDICAL  ASPECTS  OF  CANCER 

of  the  greatest  benefit  also  in  axillary  and 
other  metastases.  In  other  cases  the  con- 
tinuous painting  with  ichthyol  (50  p.c.  in 
water)  has  seemed  to  be  of  great  service, 
in  combination  with  other  proper  treat- 
ment: all  of  this  in  earlier  cases,  before 
ulceration  has  occurred. 

After  ulceration  has  set  in,  either  in  pri- 
mary or  recurrent  cases,  proper  local  medi- 
cation is  very  important.  The  ordinary 
micro-organisms,  finding  a  suitable  nidus, 
very  readily  germinate  and  add  greatly  to 
the  suppuration,  and  consequent  exhaus- 
tion and  pain,  and  by  their  toxins,  aid  also 
in  the  general  contamination  of  the  blood 
and  tissues.  Hydrogen  peroxide,  laid  on 
with  pledgets  of  absorbent  cotton  is  often 
of  great  service  in  changing  the  conditions 
of  the  part,  and  when  followed  by  Russian 
oil,  also  applied  with  cotton,  makes  a  most 
satisfactory  dressing.  Adrenalin  1-1000 
is  also  often  of  service,  both  in  checking 
active  hemorrhage,  and  in  relieving  pain. 


TREATMENT  OF  CANCER      167 

and  shrinking  np  tlie  granulations.  Ich- 
tliyol,  10  to  25  per  cent,  in  Tvater,  and  per- 
manganate of  potash  in  water,  1  to  2  per 
cent,  are  also  often  of  service,  likewise 
acetate  of  aluminium,  3  to  5  per  cent. : 
methylin  blue  and  fuchsin  in  watery  solu- 
tion, 1  to  2  j)er  cent,  were  formerly  much 
used,  and  often  served  a  good  purpose. 
It  is  understood,  however,  that  none  of 
these  measures  have  any  great  curative 
effect  on  cancer,  but  as  contributory  ele- 
ments they  should  never  be  neglected. 
Ichthyol  ointment  (I>  Ichthyol  oss-5i  Zinc 
Oxid  OSS  Unguent.  Aquae  Eosse  51)  often 
proves  most  satisfactory,  spread  on  thin 
layers  of  absorbent  cotton,  and  changed 
several  times  daily,  after  soaking  the  part 
with  one  of  the  liquids  above  mentioned. 

Time  does  not  permit  us  to  go  into  the 
matter  of  the  X-ray,  which  undoubtedly 
has  often  been  of  great  service  in  certain 
cases  of  cancer:  it  should  be  carefully  but 
systematically  employed,  once  or  twice  a 


168   MEDICAL  ASPECTS  OF  CANCER 

week  in  connection  with  other  medical 
treatment ;  radium  can  also  be  of  real  serv- 
ice in  these  cases.  In  some  inoperable 
cases  a  mild  surgery,  especially  with  the 
actual  cautery,  in  the  way  of  removing 
exuberant  masses,  which  would  have  to 
slough  off,  can  add  much  to  the  good  prog- 
ress of  the  case,  and  the  occasional  excision 
of  cutaneous  nodules  removes  just  so  much 
cancerous  tissue,  which  by  its  secretion 
would  poison  the  system. 

In  our  study  thus  far  we  have  seen  that 
there  is  much  to  be  done  for  cancer  besides 
the  surgical  removal  of  the  offending  mass, 
the  existence  of  which  is  an  opprobrium  to 
medical  science,  which  has  not  thus  far 
guarded  mankind  against  it :  and  until  time 
has  passed,  and  by  right  living  and  proper 
medical  attention  cancer  has  ceased  to  be 
produced,  or  become  greatly  diminished, 
surgery  will  probably  be  a  great  factor  in 
its  treatment,  as  its  mortality  statistics  are 
constantly  improving.     But  there  can  be  no 


TKEATMENT  OF  CANCER      169 

question  but  that  with  the  adoption  of 
proper  dietary  and  medical  treatment, 
even  from  the  first  suspicion  of  a  malig- 
nant growth,  and  before,  as  also  after  oper- 
ation, the  final  results  of  operative  pro- 
cedure will  be  even  far  better  than  have 
been  yet  attained. 


LEG TUBE  YI 

CLINICAL    CONSIDEEATIONS    AND    CONCLUSIONS 

The  test  of  everything  lies  in  the  results 
obtained.  Theories,  discussions,  and  argu- 
ments are  all  unavailing  unless  results 
show  their  truth.  In  medicine,  however, 
it  is  sometimes  difficult  to  demonstrate  re- 
sults until  after  the  lapse  of  time,  as  was 
well  illustrated  by  the  preposterous  claims 
first  put  forth  for  ^'606,'^  which  is  grad- 
ually attaining  about  its  correct  status. 
The  same  is  true  in  regard  to  the  surgery 
of  carcinoma,  where  operations  which  for- 
merly were  attended  with  veiy^  bad  results 
have  gradually  been  improved,  so  that, 
while  the  late  Dr.  Agnew  of  Philadelphia 
once  said,  toward  the  close  of  his  life,  that 
he  did  not  know  if  he  had  ever  been  justi- 
fied in  any  operation  he  had  performed  on 

170 


CLINICAL  CONSIDERATIONS     171 

this  disease,  the  best  surgeons  are  now 
claiming  notable  successes,  with  relatively 
good  percentages  of  recovery:  but  here 
again,  time  comes  in,  and  while  the  three- 
year  limit  of  freedom  from  recurrence  is 
valuable,  it  is  still  said  that  fully  90  per 
cent,  of  those  who  have  once  been  affected 
with  true  cancer,  die  of  the  disease,  and  its 
general  mortality  is  still  increasing  in  spite 
of  all  surgery.  Dr.  John  B.  MurjDhy  of 
Chicago,  has  also  repeatedly  expressed 
himself  most  pessimistically  in  regard  to 
the  ultimate  results  of  the  surgical  treat- 
ment of  carcinoma,  especially  in  those  pa- 
tients who  are  fat,  and  with  lax  tissue,  that 
is,  exhibiting  evidences  of  imperfect  met- 
abolism. 

Dietetic  and  medical  treatment  of  can- 
cer, in  the  fullest  sense,  have  never  yet 
been  given  a  fair  and  fully  intelligent  trial 
on  a  scale  large  enough  to  produce  general 
conviction  in  regard  to  their  value.  Many 
cases  have  occurred  here  and  there  which 


172   MEDICAL  ASPECTS  OF  CANCEE 

have  recovered  spontaneously,  that  is, 
without  surgical  interference,  and  often 
really  to  the  surprise  of  the  medical  at- 
tendant: this  of  itself  shows  that  under 
certain  circumstances  something  may  occur 
in  the  system  which  causes  the  malignant 
process  to  cease,  and  the  cells  to  return  to 
a  normal  function.  This  certainly  should 
be  a  stimulus  to  discover  what  the  reason 
is  for  this  beneficial  change,  and  we  be- 
lieve that  it  is  to  be  found  in  what  has  pre- 
ceded in  these  lectures. 

When  the  New  York  Skin  and  Cancer 
Hospital  was  founded,  over  thirty  years 
ago.  Cancer  was  included  with  Diseases  of 
the  Skin,  in  the  hope  and  expectation  that 
in  studying  the  internal  causes  of  the  lat- 
ter light  would  be  thrown  on  the  etiology 
of  carcinoma,  which,  as  we  know,  is  a  dis- 
ease of  epithelial  elements ;  and  the  earlier 
Eeport  of  the  Hospital  shows  but  one  de- 
partment, including  Cancer  with  Skin  Dis- 
eases, with  operating  surgeons  and  a  gynae- 


CLINICAL  CONSIDERATIONS     173 

cologist  to  assist,  whenever  tlieir  services 
were  requested  by  the  physicians  in  charge. 
Before  long,  however,  for  reasons  which 
cannot  now  be  given,  and  against  the  judg- 
ment of  the  present  speaker,  the  plan  was 
changed,  and  a  separate  cancer  depart- 
ment was  erected  under  the  exclusive 
charge  of  surgeons.  A  Prize  Fund  was 
also  early  established,  which  has  been 
slowly  increasing,  for  the  discovery  of  a 
cure  for  cancer  by  other  than  surgical  re- 
moval. 

For  thirty  or  forty  years  I  have  held 
very  much  the  same  views  regarding  can- 
cer which  have  been  presented  in  these  lec- 
tures, and  have  acted  on  them  more  or  less 
strongly,  and  in  later  years  very  strin- 
gently, and  have  rarely  seen  cause  for  re- 
gret. For  one  reason  or  another  I  have 
also  had  many  hundreds  of  patients,  with 
various  affections,  on  a  vegetarian  diet 
over  varying  periods :  in  a  number  of  cases 
I  have  records  extending  over  many  years, 


174   MEDICAL  ASPECTS  OF  CANCER 

in  whicli  I  have  observed  the  patients  from 
time  to  time  (one  psoriasis  patient  having 
continued  it  for  over  twenty  years)  and 
with  only  the  best  results,  so  I  trust  that 
you  will  accept  and  test  the  validity  of  my 
statements. 

In  looking  over  my  case  histories  in  pri- 
vate practice  I  find  that  I  have  more  or 
less  complete  records  of  96  cases  of  carci- 
noma, mostly  of  the  breast  (two  of  them 
having  Paget 's  disease),  29  of  sarcoma  in 
various  situations,  and  619  of  epithelioma 
of  different  degrees  of  severity,  of  which 
four  others  had  Paget 's  disease;  a  total  of 
744  patients  with  these  forms  of  neoplasm. 
Some  of  these  patients  were  seen  in  consul- 
tation, others  only  once  or  for  a  brief 
period,  but  many  of  them  were  under  care 
and  observation  for  a  greater  or  less  length 
of  time.  During  the  past  year  I  have  also 
treated  on  the  plan  here  indicated  a  num- 
ber of  cases  of  recurrent  carcinoma  in  the 
New    York    Skin    and    Cancer    Hospital, 


CLINICAL  CONSIDERATIONS     175 

which  have  been  submitted  to  very  careful 
laboratory  study,  some  of  whom  have  ex- 
hibited decidedly  favorable  results:  some 
of  these  will  be  referred  to  later,  but  they 
are  too  recent  to  afford  positive  data,  and 
I  prefer  to  confine  my  consideration  mainly 
to  private  patients,  in  regard  to  whom 
more  reliable  evidence  can  be  obtained. 

I  will  not  weary  you  with  any  full  analy- 
sis of  these  cases,  nor  will  I  consider  any 
of  them  except  those  of  carcinoma:  for 
while  I  believe  that  sarcoma  is  of  the  same 
nature  and  origin,  save  that  it  relates  to 
connective  tissue  cells,  but  few  of  the  cases 
were  submitted  long  enough  to  a  vigorous 
treatment  calculated  to  yield  efficient  re- 
sults. I  may  say  in  regard  to  the  cases  of 
epithelioma,  mainly  of  the  skin,  that  some 
of  the  more  severe  ones  showed  very 
markedly  the  benefit  of  dietetic  and  medici- 
nal measures  of  the  character  now  being 
considered,  and  that  it  is  my  custom  to 
treat  such  in  the  same  manner :  for  reason 


176   MEDICAL  ASPECTS  OF  CANCEE 

would  seem  to  show  that  the  same  causes 
would  produce  abnormal  proliferation  of 
epithelial  elements  on  the  cutaneous  sur- 
face as  well  as  in  other  parts  of  the  body. 

In  regard  to  the  cases  of  carcinoma  there 
were  6  in  males  and  90  in  females ;  of  these 
the  right  breast  was  affected  42  times,  the 
left  breast  45  times,  and  both  breasts  3 
times.  In  28  cases  the  patients  were  oper- 
ated on  surgically  before  adequate  treat- 
ment had  been  employed;  many  of  these 
were  earlier  cases,  or  those  seen  in  consul- 
tation. In  seven  instances  it  seemed  wise 
to  have  an  operation,  after  a  more  or  less 
faithful  trial  of  medical  treatment.  There 
were  no  cases  of  cancer  of  internal  organs, 
except  metastases,  as  these  would  not  natu- 
rally come  to  me.  The  average  age  of  the 
breast  cases  was  51.8  years. 

In  the  large  majority  of  cases,  except 
those  who  had  been  surgically  operated  on, 
the  diagnosis  was  clinical  only,  as  it  is  an 
accepted  fact  that  it  is  very  unwise  to  make 


CLINICAL  CONSIDERATIONS     177 

a  biopsy,  even  before  surgical  removal,  and 
manifestly  imi^roper  where  this  is  not  un- 
dertaken; but  in  most  of  the  cases  there 
was  the  indei3endent  diagnosis  of  one  or 
more  other  medical  men,  and  many  of  the 
patients  came  to  me  on  account  of  threat- 
ened operations  by  prominent  surgeons, 
and  even  after  these  had  been  arranged 
for;  in  27  cases  there  had  been  previous 
surgical  removal  with  recurrence,  and  in 
several  cases  more  than  one  operation,  with 
again  recurrence. 

The  exact  duration  of  cancer  before 
coming  under  observation  is  always  an  un- 
certain item,  for  undoubtedly  a  tumor 
starts  in  an  individual  cell  or  group  of 
cells,  and  has  probably  been  forming  some 
time  before  being  noticed  by  the  patient  or 
attracting  attention  in  any  way.  The  aver- 
age stated  duration  of  the  disease  was  1.6 
years  before  coming  under  observation. 

Surgeons  are  fully  agreed  that  the 
earlier  a  tumor  is  recognized  and  removed 


178   MEDICAL  ASPECTS  OF  CANCER 

the  better  tlie  prospect  of  ultimate  success, 
and  this  is  eminently  true  in  regard  to 
remedial  measures  other  than  surgical: 
for  as  we  have  seen,  after  a  cancerous  proc- 
ess is  well  under  way  its  cells  secrete  a 
something  which  hastens  the  general  de- 
pravement  of  the  system,  and  quickens  the 
growth  of  the  neoplasm,  and  naturally 
greatly  increases  the  difficulty  of  overcom- 
ing the  dyscrasia. 

Thus  in  the  effort  to  get  at  and  remove 
all  possible  or  prospective  cancerous  le- 
sions, many  innocent  or  non-mahgnant 
adenomata,  etc.,  are  operated  on,  which  are 
afterwards  found  to  be  such  microscopic- 
ally. In  the  same  way  it  is  quite  possible 
that  some  of  the  small  breast  tumors  which 
have  disappeared  under  the  dietetic  and 
medical  measures  here  described  were  still 
non-malignant,  and  should  not  be  grouped 
with  carcinoma. 

It  is  fair  to  say,  therefore,  that  among 
my  notes  are  also  22  cases  of  breast  tumors 


CLINICAL  CONSIDERATIONS     179 

wliich  have  been  excluded  from  the  carci- 
noma list,  and  entered  with  other  titles, 
such  as  abscess,  cyst,  chronic  mastitis, 
adenoma,  etc.  But  I  claim  that  even  if 
some  of  these  also  disappear  under  the 
measures  we  are  considering,  as  they  fre- 
quently have  done,  it  is  a  better  and  more 
desirable  result  than  if  they  had  been  re- 
moved by  the  knife :  for  in  the  former  case 
the  cause  which  induced  the  unnatural 
growth  has  been  overcome,  whereas  by 
surgery  only  the  obnoxious  mass  has  been 
dislodged,  and  perhaps  with  it  adjoining 
tissue  and  glands,  but  nothing  has  been  ac- 
complished toward  checking  the  cause  pro- 
ducing the  offending  lesion.  But  the  very 
fact  of  the  frequent  recurrences  after  oper- 
ation, in  the  neighboring  skin  or  elsewhere, 
demonstrates  the  fact  that  surgery  is  but 
an  attempt  to  rectify  past  errors,  which 
might  or  might  not  have  been  prevented  by 
careful  medical  foresight  and  action;  we 
must,  however,  be  thankful  for  the  meas- 


180  MEDICAL  ASPECTS  OF  CANCER 

ure  of  success  which  has  followed  the  noble 
efforts  of  our  distinguished  surgeons,  only 
it  is  to  be  hoped  that  hereafter  other  meas- 
ures will  also  be  more  commonly  adopted, 
looking  towards  a  prevention  of  the  recur- 
rence of  carcinoma  after  operation. 

Not  to  detain  you  too  long  with  these 
clinical  considerations,  I  would  like  to  give 
the  details  of  a  few  of  the  cases  which  have 
been  most  striking. 

Mrs.  B.  E.  C,  aged  44,  was  first  seen  on 
account  of  trouble  in  the  right  breast,  on 
September  19,  1892.  She  then  had  a  flat 
tumor  in  the  outer  lower  segment,  an  inch 
and  a  half  in  diameter,  rather  sharply  de- 
fined, and  tender  on  pressure  at  the  sides, 
which  she  had  noticed  about  two  months. 
Not  satisfied  with  the  diagnosis  of  cancer, 
and  hesitating  at  the  thought  of  medical 
treatment,  she  consulted  a  well-known, 
prominent  surgeon,  i^^ho  pronounced  the 
tumor  as  undoubtedly  cancer,  and  urged  its 
instant  removal ;  this  I  did  not  know  until 


CLINICAL  CONSIDEKATIONS     181 

slie  informed  me  of  it  some  time  later, 
after  the  tumor  had  entirely  disappeared 
under  treatment.  I  saw  her  at  frequent 
intervals  for  six  months,  and  the  breast 
became  entirely  normal.  Four  years  later 
she  was  again  seen  in  regard  to  the  meno- 
pause, which  she  was  undergoing,  and  the 
breast  was  found  still  to  be  normal:  she 
was  maintaining  her  diet.  Nearly  three 
years  later  I  learned  from  her  husband 
that  she  was  in  perfect  health,  with  abso- 
lutely no  breast  trouble,  and  for  eight  years 
later,  while  he  himself  was  under  occa- 
sional treatment,  I  learned  repeatedly  that 
she  remained  still  perfectly  well,  over  six- 
teen years  after  beginning  treatment,  with 
no  recurrence  of  the  breast  tumor. 

Miss  B.  M.  L.,  aged  45,  was  first  seen  on 
January  4,  1894,  with  a  tumor  in  the  left 
breast,  which  had  been  diagnosed  as  can- 
cer by  three  medical  men,  and  one  of  them, 
a  surgeon  of  prominence,  had  arranged  for 
immediate  surgical  removal  the  next  day. 


182   MEDICAL  ASPECTS  OF  CANCER 

The  mass  was  situated  in  the  upper  and 
outer  quadrant,  well  defined,  not  painful 
on  moderate  handling,  but  subsequently  she 
experienced  pain  in  it.  Two  months  later 
the  lump  was  recorded  as  less  distinct  and 
flatter,  and  within  eleven  months  it  had  en- 
tirely disappeared.  A  month  or  two  later 
she  had  some  pain  in  the  breast,  in  connec- 
tion with  the  menstrual  disturbance  ac- 
companying the  menopause,  but  no  trace 
of  the  tumor.  On  Nov.  8th,  1905,  she 
called,  bringing  a  relative  for  treatment, 
and  the  breast  was  found  perfectly  normal, 
and  again  ^ve  years  later  she  called,  with 
another  trouble,  the  breast  still  remaining 
perfectly  well,  also  sixteen  years  after  first 
coming  under  treatment. 

Miss  J.  M.  A.,  aged  45,  was  first  seen  Oc- 
tober 12th,  1905,  with  a  tumor  of  the  left 
breast,  above,  toward  the  median  line,  near 
the  nipple,  not  painful  on  handling,  though 
there  was  some  pain  afterwards,  and  it 
had  been  awaking  her  with  pain  at  night 


CLINICAL  CONSIDERATIONS     183 

for  some  months,  with  also  a  mmib,  shoot- 
ing pain  in  the  daytime.  She  had  seen  a 
number  of  medical  men  always  with  the 
diagnosis  of  cancer,  but  she  had  declined 
operation.     Two  months  later,  Dec.  15th, 

1905,  it  was  recorded  that  there  was  very 
little  to  be  felt  in  the  breast,  and  there  was 
no  pain  at  any  time,  and  on  January  5th, 

1906,  both  breasts  were  the  same  on  palpa- 
tion, with  no  sign  of  the  former  tumor. 
For  one  reason  or  another  she  has  been 
seen  from  time  to  time,  almost  up  to  the 
present  date,  and  remains  perfectly  free 
from  her  former  trouble,  a  period  of  over 
nine  years.  She  has  been  a  most  faithful 
patient,  adhering  strictly  to  diet  and  more 
or  less  medication,  except  when  on  certain 
occasions  I  have  let  up  on  the  same;  and 
all  the  time  from  the  first  she  has  been  un- 
der great  strain  of  work,  mental  and  phys- 
ical, as  a  city  missionary. 

Another  very  similar  case  was  in  the 
person  of  Miss  G.  M.,  aged  44,  who  has 


184   MEDICAL  ASPECTS  OP  CANCER 

been  under  constant  observation  and  treat- 
ment off  and  on  for  various  troubles  from 
November  13,  1905,  until  yesterday.  Fif- 
teen years  previous  to  her  first  visit  she 
had  fallen  and  struck  the  left  breast  which 
was  bruised,  but  the  effects  wore  off  in 
some  months,  and  there  was  no  sensation 
in  the  breast  for  some  years.  Then  7  or  8 
years  later  she  began  to  have  pain  in  the 
breast,  aggravated  before  and  during  men- 
struation, which  had  continued  until  her 
visit,  and  for  the  last  months  she  had  been 
kept  from  her  work  in  school,  the  pain  be- 
ing severe  in  the  breast,  and  more  recently 
in  the  axilla :  in  July  there  had  been  bleed- 
ing from  the  nipple.  She  had  seen  a  num- 
ber of  medical  men,  with  the  diagnosis  of 
cancer,  and  one  surgeon  of  prominence  in 
one  of  the  large  hospitals  had  strongly 
pressed  for  an  immediate  operation. 

When  first  seen  there  was  a  tumor  be- 
tween two  and  three  inches  in  diameter,  in 
the  upper,  inner  segment  of  the  left  breast. 


CLINICAL  CONSIDERATIONS     185 

hard,  sharply  defined,  and  more  or  less 
nodular  on  the  surface:  there  were  some 
enlarged  glands   in  the   left   axilla.     She 
had  long  been  constipated  and  was  passing 
about  60  per  cent,  of  the  amount  of  urinary 
solids  proper  for  her  weight.     Under  very 
active    treatment    it    was    recorded    four 
weeks  later  that  there  had  been  hardly  any 
sensations  in  the  breast  during  the  previ- 
ous week,  that  the  tumor  had  diminished 
materially    in    size,    with    only    moderate 
hardness,  and  that  she  was  now  out  doors 
every  day,  and  feeling  much  better.     One 
month  later  it  was  recorded  that  the  breast 
was  very  well  and  on  examination  was-  al- 
most the  same  as  the  other,  there  being 
some  general  caking  in  both :  she  had  had 
no  pain  for  some  time.     One  month  or  so 
later  she  was  again  at  her  duties  as  a  pub- 
lic school  teacher,  which  she  has  continued 
at  since,  with  rare  exceptions,  when  some 
temporary  ailment  prevented :  the  lump  in 
the  breast  did  not  wholly  disappear  for  a 


186   MEDICAL  ASPECTS  OF  CANCER 

month  or  two  later,  but  on  April  7th  it  was 
recorded  that  the  left  breast  was  the  same 
as  the  other,  and  no  glands  could  be  felt  in 
the  axilla. 

From  that  time  to  the  present  she  has 
had  a  variety  of  troubles,  rheumatic  and 
other,  and  it  has  been  difficult  to  keep  up  a 
proper  action  of  the  bowels  and  kidneys; 
but  in  spite  of  strenuous  and  often  exhaust- 
ing work  as  a  New  York  City  public  school 
teacher,  she  has  had  no  return  of  the  breast 
trouble,  now  for  over  nine  years.  A  sister, 
aged  60,  has  just  died  with  cancer  of  the 
stomach  in  a  distant  country  town. 

I  could  multiply  these  histories  but  do 
not  want  to  tire  you,  though  I  do  want  to 
mention  one  more  patient,  to  show  what 
can  be  done  in  the  case  of  recurrent  carci- 
noma, after  operation,  of  which  I  have  had 
a  number  of  cases  with  varying  results,  ac- 
cording to  the  duration  and  severity  of  the 
disease. 

Miss  H.  M.,  aged  61,  came  to  me  June 


CLINICAL  CONSIDERATIONS     187 

21st,    1913,    with    the    following   history: 
About  two  years  previously  a  lump  ap- 
peared in  the  outer,  lower  segment  of  the 
left  breast,  which  was  removed  in  August, 
1911 ;  this  healed  soon,  leaving  a  good  axil- 
lary scar,  and  there  was  no  thought  of  trou- 
ble until  two  months  before  her  visit,  when 
a  small  red  spot  appeared  near  the  edge  of 
the  sternum.     Tliis  enlarged  and  hardened 
and  others  appeared  around  the  scar,  until, 
when  seen  there  were  a  dozen  red  nodules 
up  to  half  an  inch  in  diameter,  near  the  cen- 
ter of  the  former  site  of  the  breast,  with 
others,  not  red,  above;  with  the  tense  skin 
and  rapidly  developing,  multiple  nodules 
here  and  there,  further  surgical  operative 
procedure  was  out  of  the  question. 

Since  that  date  she  has  been  under  strict 
vegetarian  diet  and  medication,  including 
thyroid  from  time  to  time,  with  repeated 
application  of  X-rays,  and  under  all 
these  measures  together  many  of  the 
nodules  have  disappeared;  although  some 


188   MEDICAL  ASPECTS  OF  CANCER 

new  ones  have  formed,  several  of  which 
have  been  removed  under  local  anaes- 
thesia, the  wounds  healing  kindly.  As 
she  resides  some  distance  from  the  city 
she  has  not  been  seen  since  October  7th, 
1914,  she  wishing  to  take  the  X-rays 
nearer  home,  but  she  was  earnestly 
charged  to  continue  also  the  dietetic  and 
other  treatment*  In  this  instance  the  pa- 
tient has  lived  comfortably  and  without 
pain  for  almost  sixteen  months  after  com- 
ing under  treatment,  and,  although  she  has 
lost  some  flesh,  the  active  cancerous  proc- 
ess, which  would  otherwise  have  carried 
her  off  long  ago,  has  been  in  a  measure 
checked.  What  will  be  the  further  history 
of  the  case  one  cannot  tell,  for  it  is  quite 
possible  that  being  away  from  my  care  she 
may  neglect  dietetic  and  medicinal  treat- 
ment, trusting  only  to  the  X-rays,  which, 
of  course,  cannot  influence  the  real  nature 
and  course  of  the  disease. 

Reference  was  made  to  certain  cases  of 


CLINICAL  CONSIDEEATIONS     189 

recurrent  cancer  in  the  Hospital  which  had 
been  under  active  medical  treatment  dur- 
ing the  past  year,  with  careful  laboratory 
studies,  but  it  is  naturally  too  early  to  re- 
port anything  very  definite  in  regard  to 
them,  especially  as  most  of  tkem  were  des- 
perate cases,  which  had  advanced  far  be- 
yond any  possible  operative  relief.  More- 
over several  of  them  remained  but  a  short 
time  under  treatment,  as  it  is  very  difficult 
to  convince  this  class  of  patients  that  any 
possible  benefit  can  accrue  from  anything 
but  an  operation,  and  this  being  impossible 
they  often  give  up  and  leave,  preferring  to 
die  at  home;  moreover  the  dietary  re- 
straint seems  also  very  irksome  and  use- 
less to  them  and  their  friends.  In  one 
particular  patient,  however,  there  was 
such  a  remarkable  improvement  that  it  is 
worth  reporting  to  you. 

Mrs.  C.  M.  was  first  seen  February  12th, 
1914.  Nineteen  years  previously  she  had 
an    abscess    of    the    right    breast,    which 


190   MEDICAL  ASPECTS  OF  CANCER 

healed  and  left  a  tumor  the  size  of  a  pig- 
eon's egg  in  the  inner,  npper  quadrant  of 
the  breast ;  this  remained  quiescent  until  it 
began  to  enlarge,  eleven  months  before  it 
was  removed  at  the  New  York  Skin  and 
Cancer  Hospital,  November  14th,  1912. 
The  tumor  was  then  about  the  size  of  a 
hen's  eggy  with  an  area  of  skin  the  size  of 
a  quarter,  attached  to  it:  a  second  tumor 
was  felt  just  below  the  nipple,  which  was 
not  retracted,  and  the  axillary  glands  were 
involved :  there  were  no  signs  of  metastases 
in  the  abdomen.  A  complete  operation 
was  then  performed,  with  dissection  of  the 
glands  in  the  axillary  and  supra-clavicular 
regions,  and  she  was  discharged  January 
16th,  1913. 

On  February  9th,  1914,  she  returned  to 
the  Hospital  and  was  placed  under  medical 
treatment,  with  vegetarian  diet.  There 
was  then  an  ulceration  along  the  line  of  in- 
cision, from  the  second  to  the  fourth  rib, 
with  many  nodules  around  it,  averaging  a 


CLINICAL  CONSIDERATIONS     191 

third  of  an  incli  in  diameter,  raised  and 
reddened.  The  liver  extended  two  inches 
below  the  edge  of  the  ribs,  with  a  hard  and 
nodular  margin;  the  right  arm  was  enor- 
mously swollen  and  helpless.  When  she 
left  the  Hospital,  June  20th,  1914,  the  ul- 
cer had  entirely  closed,  many  of  the  cuta- 
neous nodules  had  entirely  disappeared, 
the  arm  had  returned  to  normal  size,  like 
the  other,  by  measurement,  and  the  liver 
had  retracted  to  a  trifle  below  the  margin 
of  the  ribs,  with  hardly  any  nodules  to  be 
felt.  The  treatment  had  included  twenty- 
five  X-ray  exposures,  from  8  to  10  minutes 
each,  about  twice  a  week,  over  three  areas 
each  time. 

AVhile  in  the  Hospital  careful  laboratory 
investigations  were  made,  according  to 
a  definite  schedule.  The  blood,  studied 
weekly,  maintained  a  haemoglobin  of  80+ 
for  over  two  months,  then  fell  a  little,  and 
again  rose.  The  erythrocytes  were  3,262,- 
000    on    entering,    and    rose    within    two 


192   MEDICAL  ASPECTS  OF  CANCER 

months  to  4,282,000,  then  fell  a  little  and 
rose  again  to  almost  4,000,000:  tlie  leuco- 
cytes were  9,000  on  entering,  and  fell  to 
5,200  just  before  leaving,  the  poly-nuclear 
69  per  cent,  on  admission,  fell  to  60  per 
cent.,  and  again  rose  a  little,  and  the  pro- 
portion of  the  other  forms  remained  about 
normal.  The  urine,  volumetrically  an- 
alyzed every  three  days,  was  kept  a  little 
below  the  normal  acidity,  and  the  specific 
gravity  a  little  low,  with  a  free  daily 
amount  of  excretion,  largely  by  Bethesda 
water:  in  spite  of  the  vegetarian  diet  the 
urea  excretion  was  not  much  below  nor- 
mal, and  sometimes  above,  the  chlorides 
were  diminished,  owing  to  the  rather  small 
amount  of  food  taken,  the  phosphates  va- 
ried a  little  above  and  below  normal,  there 
was  never  any  indican,  and  the  sulphates 
averaged  a  trifle  below  normal.  The  sa- 
liva, tested  before  and  after  each  meal,  was 
acid  at  first,  but  became  neutral  and  alka- 
line off  and  on.     The  weight,  taken  weekly. 


CLINICAL  CONSIDERATIONS     193 

fell  a  little  from  the  first,  but  maintained 
a  good  level,  and  rose  a  little  before  slie 
left  the  Hospital. 

Tills  vas  a  very  difficult  patient  to  man- 
age, as  she  was  a  very  ignorant  Polish 
-svoman,  tvIio  often  rebelled  at  the  diet,  and 
wearied  of  the  routine  and  restrictions  im- 
posed; she  left  the  Hospital  June  20th, 
1914,  against  my  wish,  but  with  as  great  a 
change  in  her  physical  condition  and  dis- 
ease as  could  be  imagined,  after  about  four 
months  and  a  half  treatment,  carried  out 
under  disadvantageous  circumstances. 

One  other  case,  seen  recently,  where  the 
disease  was  recurrent  after  three  opera- 
tions, desei-ves  mention,  although  it  will  be 
some  time  before  any  decisive  result  can 
be  reported. 

Mrs.  W.  C,  aged  45,  was  first  seen  Sep- 
tember 17th,  1914.  Nearly  four  years  pre- 
viously she  had  noticed  a  lump  in  the  left 
breast  which  was  removed  on  January  6th, 
1911,  but  it  soon  regrew,  and  a  complete 


194   MEDICAL  ASPECTS  OF  CANCEE 

operation  was  performed  at  the  New  York 
Skin  and  Cancer  Hospital,  May  30th,  1911. 
Two  years  later  there  was  some  return, 
and  she  was  again  operated  on  at  the  Hos- 
pital, May  30th,  1914.  About  two  months 
before  her  first  visit,  September  17th, 
1914,  a  swelling  of  the  sternum  was  no- 
ticed, and  soon  another  above  it,  both  of 
which  increased  pretty  rapidly  to  the  time 
of  her  visit.  Wlien  seen  there  was  a  hard 
mass  in  the  scar  over  the  sternum,  about 
an  inch  and  a  half  long,  raised  a  quarter 
of  an  inch  or  so,  reddened  and  immovable : 
an  inch  or  so  above  it  was  another,  smaller 
one,  not  reddened:  they  were  not  particu- 
larly painful  on  moderate  handling,  but 
painful  when  at  hard  housework.  When 
last  seen,  December  7th,  both  lumps  had 
subsided  fully  one-half,  there  was  no  pain 
at  any  time,  and  her  general  condition  had 
improved  immensely,  she  feeling  better 
than  she  did  four  or  five  years  ago,  that  is, 
before  the  beginning  of  the  cancerous  de- 


CLINICAL  CONSIDERATIONS     195 

velopment:  she  has  been  working  all  the 
time,  unusually  hard,  as  janitor  of  four 
buildings  and  also  going  out  scrubbing  and 
washing.  She  weighed  1571/4  pounds 
when  first  seen,  then  ran  down  to  154,  but 
is  again  gaining,  being  1551/2  at  her  last 
visit.  The  outcome  of  this  case  it  is,  of 
course,  impossible  to  conjecture,  for  one 
can  seldom  be  sure  that  patients  will  be  ab- 
solutely faithful  to  treatment,  for  a  long 
enough  time,  but  certainly  the  change  in 
the  woman  and  in  the  lesions  in  this  two 
months  and  a  half  has  been  remarkable, 
compared  with  the  increasing  development 
of  the  disease  in  the  two  months  previous. 

I  must  mention  one  more  case,  which,  al- 
though fatal,  exhibited  some  of  the  good 
results  of  careful  medical  treatment  even 
when  a  primary  case  had  advanced  far  be- 
yond the  possible  aid  of  surgery. 

Mrs.  M.  B.  J.,  aged  68,  a  private  patient, 
was  first  seen  on  February  17th,  1914. 
Two  years  previously  she  noticed  a  lump 


196   MEDICAL  ASPECTS  OF  CANCER 

in  the  upper  part  of  the  right  breast,  after 
great  and  repeated  mental  distress  from 
the  death  of  a  number  of  very  near  rela- 
tives, and  a  sister's  mental  derangement; 
the  great  nervous  strain  had  been  attended 
with  various  bilious  attacks  and  nervous 
indigestion.  The  mass  increased  steadily 
in  size  and  was  kept  concealed  even  from 
her  family,  until  the  day  before  she  called, 
when  her  family  physician  who  was  con- 
sulted saw  that  it  was  far  beyond  the  pos- 
sible hope  from  any  operation,  in  which 
view  a  surgeon  concurred. 

When  seen  the  whole  breast  was  in- 
volved, was  double  the  size  of  the  other, 
hard,  immovable,  and  with  an  adherent 
crust  over  an  ulcerating  surface  on  its 
lower  half,  several  inches  in  diameter, 
from  beneath  which  was  a  moderate  dis- 
charge: the  axillary  glands  were  enor- 
mously enlarged,  as  also  the  supra-clav- 
icular, and  she  was  strongly  cachectic. 
She  was  placed  on  an  absolute  vegetarian 


CLINICAL  CONSIDERATIONS     197 

diet,  with  no  coffee  or  tea,  and  appropriate 
medical  treatment,  and  the  breast  kept 
painted  with  fifty  per  cent,  ichthyol  and 
water,  care  being  taken  not  to  disturb  the 
adherent  crnst.  In  a  very  short  time  the 
discharge  ceased,  and  the  protective  crust 
adhered  until  her  death  from  exhaustion, 
with  pulmonary  oedema,  on  September  9th, 
1914.  On  August  15th  it  was  recorded  that 
the  breast  had  done  very  well,  that  it  was 
soft  and  movable,  and  not  larger  than  the 
other  breast,  with  no  discharge,  and  no 
pain  since  a  short  time  after  beginning 
treatment:  the  axillary  glands  had  dimin- 
ished three-quarters  in  size,  and  the  supra- 
clavicular glands  were  also  very  much 
smaller. 

And  now,  gentlemen,  my  task  is  done. 
I  have  tried  to  let  you  see  cancer  through 
my  spectacles,  as  I  have  seen  it  for  very 
many  years  past,  and  to  share  with  me  my 
optimism  in  regard  to  the  prophylaxis  and 
cure  of  cancer,  if  only  there  can  be  suffi- 
cient enlightenment  in  the  profession  and 


198   MEDICAL  ASPECTS  OF  CANCER 

public:  and  I  must  tell  you  that  in  collat- 
ing and  preparing  the  material  to  support 
my  long  held  views  I  have  expended  very 
much  more  time  and  labor  in  study,  for 
some  months  past,  than  I  could  have  be- 
lieved possible.  But  as  the  subject  devel- 
oped, and  as  I  discovered  more  and  more 
support  for  my  thesis,  there  was  a  fas- 
cination about  the  work  which  I  could  not 
resist;  and  if  I  have  tried  you  with  the 
many  details  of  proof  presented  I  beg  that 
you  will  pardon  me:  for  I  wanted  to  pre- 
sent the  subject  so  strongly  that  my  hear- 
ers, at  least,  would  accept  the  propositions 
I  have  developed,  and  believe  what  I  have 
said  in  regard  to  my  own  experience  with 
the  terrible  disease  under  consideration, 
and  act  upon  both,  and  thus  aid  some  suf- 
ferers with  cancer. 

From  my  recent  article  on  **The  Eela- 
tion  of  Diet  to  Cancer''  many  medical  jour- 
nals have  quoted  me  as  ascribing  the  dis- 
ease wholly  to  the  use  of  meat,  but  you 


CLINICAL  CONSIDERATIONS     199 

who  have  heard  these  lectures  now  know 
that  animal  proteids  are  only  one  of  the 
contributing  causes. 

I  have  tried  to  make  it  plain  that  met- 
abolic errors,  inducing  a  vitiated  blood 
stream,  are  the  basic  cause  of  the  aberrant 
action  in  the  cellular  elements  of  the  body 
which  may  ultimately  lead  to  malignant 
disease ;  and  I  have  tried  to  show  that  there 
are  many  elements  connected  with  modern 
so-called  civilization  which  conspire  to  ef- 
fect this  end.  I  have  quoted  many  who 
were  well  acquainted  with  cancer,  who  be- 
lieved that  luxurious  living,  which  includes 
much  animal  food,  coffee  and  tea,  and  alco- 
hol, with  indolence  or  want  of  sufficient 
muscular  activity  to  burn  up  the  waste 
products,  and  the  persistent  neglect  of  hy- 
gienic laws,  should  be  placed  first  among 
the  causes  of  cancer :  but  I  have  also  men- 
tioned that  the  refining  and  preparation 
and  cooking  of  food  prevented  a  proper 
supply  of  the  mineral  and  other  elements 


200   MEDICAL  ASPECTS  OF  CANCER 

of  nutrition,  and  also  tliat  nervous  influ- 
ences could  so  disturb  the  action  of  the 
organs  of  the  body  that  they  could  not  per- 
form their  functions  perfectly  in  the  elab- 
oration of  nutritive  material,  etc. 

But  I  cannot  go  over  again  all  the  mat- 
ter already  given  in  these  lectures,  and 
only  mention  these  to  remind  you  that 
there  is  no  one  single  cause  of  cancer,  and 
consequently  that  its  prophylaxis  and  cure 
can  never  be  found  in  any  one  single  rem- 
edy; hence  I  can  never  believe  in  the  sole 
use  of  thyroid,  much  less  in  the  idea  that 
sero-therapy  can  overcome  a  disease  de- 
pendent upon  the  continued  operation  of 
so  many  causes ;  and  still  less  can  I  believe 
that  the  mere  cutting  out  of  an  already 
diseased  portion  of  the  body  is  the  proper 
and  only  means  of  overcoming  such  a  mal- 
ady as  cancer. 

I  have  acknowledged  that  local  irritation 
of  many  kinds  may  be  the  proximate  cause 
for  the  development  of  a  malignant  tumor 


CLINICAL  CONSIDEEATIONS     201 

in  any  particular  locality,  as  Ewing  lias 
so  clearly  shown  in  Ms  excellent  resume  on 
pre-cancerous  lesions ;  but  I  have  also  con- 
tended that  we  should  withal  look  into  and 
overcome  the  cause;  why,  when  once 
started  by  local  injury  the  cells  should 
pursue  such  a  progressive,  aggressive,  and 
invasive  course;  and  this  is  found,  I  be- 
lieve, in  the  disturbed  character  of  the  flu- 
ids which  provide  them  with  nourishment 
for  their  abnornial  growth. 

From  this  study  of  cancer  in  regard  to 
its  nature,  frequency,  geographical  dis- 
tribution, metabolism,  dietetic  relations, 
medical  treatment,  and  clinical  consid- 
erations, what  conclusions  can  be  drawn? 
Have  we  solved  the  problem  of  cancer? 
Far  be  it  from  us  to  make  any  such  claim. 
Scientific  research  and  study  must  still  go 
on  in  the  laboratory,  but  clinical  research 
and  study,  with  laboratory  work,  on  the 
human  subject,  which  have  not  been  hith- 
erto    sufficiently     cultivated,     should     be 


202   MEDICAL  ASPECTS  OF  CANCEE 

pushed,  so  that  by  a  mass  of  carefully  re- 
corded observations  the  truth  or  falsity  of 
what  has  been  here  quoted  and  said  may  be 
refuted  or  confirmed. 

From  the  enormous  work  which  has 
been  done  on  cancer  with  the  microscope 
and  the  test  tube,  it  would  seem  sometimes 
that  research  workers  have  become  some- 
what myopic,  and  not  f arsighted  enough  to 
recognize  the  true  value  of  statistical  stud- 
ies and  clinical  observations.  In  these 
lectures  we  have  attempted  to  make  a  brief 
synthetic  study  of  some  of  the  work  which 
has  been  done  in  connection  with  cancer, 
and  from  this  we  believe  that  certain  con- 
clusions can  be  drawn ;  if  these  are  correct 
and  followed,  it  is  hoped  that  much  more 
can  be  accomplished  in  regard  to  the  pro- 
phylaxis and  cure  of  this  more  than  threat- 
ening, fatal  malady.  In  order  that  you 
may  hold  clearly  the  points  which  have 
been  made  I  want  to  give  you  a  synopsis 
or  conclusions  of  them,  as  they  have  been 


CONCLUSIONS  203 

brought  out  in  this  and  preceding  lectures. 

1.  Cancer  is  but  a  deviation  from  the 
normal  life  and  action  of  certain  of  the  or- 
dinary cells  of  the  body,  which,  for  some 
as  yet  unexplained  reason,  take  on  an  ab- 
normal or  morbid  action;  with  this  there 
is  a  continued  tendency  to  a  malignancy 
which  invades  contiguous  tissue,  and  in  the 
end  tends  to  destroy  life. 

2.  There  is  some  reason  to  believe  that 
this  action  first  takes  place  in  what  are 
known  as  ^* embryonic  rests,''  or  pre-natal, 
wrongly  placed  tissue  elements,  which, 
however,  are  now  shown  to  exist  in  every 
one,  in  many  localities :  but  the  reason  why 
they  take  on  this  malignant  action,  and 
form  cancer,  has  not  been  satisfactorily  ex- 
plained. 

3.  Cancer  is  not  wholly  due  to  traumatic 
causes,  although  those  play  a  not  incon- 
siderable part  in  its  occurrence  in  certain 
localities  and  cases. 

4.  It  is  pretty  conclusively  decided  that 


204   MEDICAL  ASPECTS  OF  CANCEE 

cancer  is  not  caused  by  a  micro-organism, 
or  parasite. 

5.  It  is  also  known  clinically  and  experi- 
mentally that  it  is  not  contagious. 

6.  Nor  is  it  hereditary  in  any  apprecia- 
ble degree. 

7.  Occupation  has  not  any  very  great  in- 
fluence on  the  occurrence  of  cancer,  al- 
though it  is  more  frequent  in  some  pur- 
suits than  in  others. 

8.  Cancer  is  not  altogether  a  disease  of 
older  age,  although  its  incidence  is  greatly 
increased  with  advancing  years. 

9.  It  does  not  especially  belong  to  or  af- 
fect any  particular  sex,  race,  or  class  of 
persons. 

10.  It  is  not  confined  to  any  location  or 
section  of  the  earth,  but  has  been  observed 
in  all  countries  and  climates. 

11.  No  single  cause  of  cancer  has  yet 
been  demonstrated,  nor  is  it  Hkely  that 
this  will  ever  be  the  case,  as  the  experi- 
mental and  other  investigations  have  cov- 


CONCLUSIONS  205 

ered  almost  every  possible  line  of  research, 
with  only  negative  results. 

12.  The  exclusion  of  almost  every  other 
possible  cause  of  cancer,  as  well  as  its 
pathological  history,  leads  to  deranged 
metabolism  as  the  only  remaining  possible 
etiological  element;  this  acts  by  inducing 
changes  in  nutrition,  which  latter  depends 
on  diet  and  the  proper  action  of  the 
secretory  and  excretory  organs,  which, 
still  further,  may  be  affected  by  nervous 
influences. 

13.  While  the  bio-chemistry  of  cancer 
throws  little  light  on  its  true  nature, 
enough  is  known  to  show  that  the  morbid 
changes  in  the  cells  are  largely  associated 
with  deranged  metabolism. 

14.  The  blood,  in  advancing  cancer, 
manifests  changes  which  indicate  vital  al- 
teration in  the  action  of  the  organs  which 
form  blood  and  control  the  nutrition  of  the 
body  and  its  cells. 

15.  Clinical  and  experimental  evidence 


206   MEDICAL  ASPECTS  OF  CANCER 

demonstrate  that  the  secretions  and  excre- 
tions of  the  body  exhibit  departures  from 
normal,  which,  while  not  pathognomonic  of 
cancer,  indicate  metabolic  disturbances  in- 
volving the  nutrition  of  the  cellular  ele- 
ments, which  disturbances  are  of  impor- 
tance. 

16.  The  evidence  seems  certain  that  the 
cancer  mass  itself,  when  fully  developed, 
secretes  a  poison  which  tends  to  augment 
its  own  growth  and  hastens  the  lethal  prog- 
ress of  the  disease. 

17.  Cancer  mortality  is  undoubtedly  on 
the  increase  in  every  portion  on  the  globe. 

18.  This  increase  seems  to  vary  in- 
versely with  the  decline  of  tuberculosis,  in 
many  localities. 

19.  The  incidence  of  cancer  seems  to  fol- 
low "closely  along  the  lines  of  modern 
civilization. 

•20.  This  extension  of  cancer  seems  to 
depend  largely  upon  the  altered  conditions 
of  life,  particularly  along  the  lines  of  self- 


CONCLUSIONS  207 

indulgence    in   eating   and    drinking,    and 
indolence. 

21.  The  augmentation  in  the  consump- 
tion of  meat,  coffee  and  alcoholic  bever- 
ages appears  to  be  coincident  with  a  very 
great,  and  proportionately  greater,  aug- 
mentation of  the  mortality  from  cancer. 

22.  The  nerve  strain  of  modem  life 
seems  to  be  an  element  of  importance,  both 
through  disturbance  of  metabolism,  and 
by  direct  action  on  morbidly  deranged 
cells. 

23.  No  single  remedy  for  cancer  will 
probably  ever  be  discovered,  since  it  is 
conceded  that  there  is  no  single  cause  for 
the  disease. 

24.  Surgery  has  improved  materially  the 
statistics  relating  to  the  mortality  of  oper- 
ative cases;  but  the  total  achievements 
along  this  line  are  insignificant  compared 
with  the  general  ultimate  mortality  of  over 
90  per  cent,  of  those  once  afflicted  with 
cancer. 


208    MEDICAL  ASPECTS  OF  CANCER 

25.  Surgery  has  had,  and  may  long  have 
its  function  to  perform  in  removing  the 
products  of  the  disease,  more  or  less  effi- 
ciently, curing  some  and  prolonging  the 
life  of  others,  but  it  can  never  hope  to  les- 
sen greatly  the  morbidity  of  cancer. 

26.  The  X-ray  and  radium,  as  also  caus- 
tics, are  in  the  same  position  as  surgery, 
and  can  do  relatively  little  more  than  cause 
to  disappear  lesions  which  have  developed 
from  causes  which  they  cannot  reach. 

27.  With  all  these  means  the  measure  of 
success,  aside  from  the  technical  skill  of 
the  operator,  largely  depends  on  the  time 
or  period  of  development  of  the  malignant 
tumor  before  treatment;  the  earlier  the 
removal  is  undertaken,  other  things  being 
equal,  the  greater  the  possibilities  of  suc- 
cess. 

28.  The  same  is  true  in  regard  to  the 
treatment  of  the  disease  by  means  other 
than  those  mentioned :  the  earlier  the  mor- 
bid process  leading  to  tumor  formation  is 


CONCLUSIONS  209 

attacked  by  dietetic,  hygienic,  and  medici- 
nal measures,  the  greater  the  promise  and 
expectation  of  success,  present  and  perma- 
nent. 

29.  The  prevention  of  cancer,  therefore, 
or  the  checking  of  its  increasing  occur- 
rence, depends  largely  upon  the  early 
enough  adoption  of  such  measures  as  will 
limit  the  agencies  which  induce  a  derange- 
ment of  the  body  juices  which  tend  to  bad 
nutrition  and  derangement  of  the  body 
cells. 

30.  The  simple  life,  with  the  avoidance 
of  the  dietetic  and  other  causes  which  have 
been  found  to  induce  cancer  in  nations  and 
individuals,  promises  the  best  hope  for  the 
arrest  of  the  rapidly  increasing  develop- 
ment of  cancer  throughout  the  world. 

31.  It  is  more  than  possible,  however, 
that  the  long  continued  operation  of  many 
baneful  causes  has  produced  such  a  degen- 
eration of  tissue  in  the  human  race,  that  it 
will  take  a  generation  or  more  of  proper 


210   MEDICAL  ASPECTS  OF  CANCER 

living  to  make  tlie  beneficial  impression  on 
the  general  incidence  of  cancer  which  is  so 
longed  for. 


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211 


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C.  P.  Huntington  Fund  for  Cancer  Re- 
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31.  Gruner— Biology  of  the  Blood  Cells,  1913, 

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32.  GwiTER—Ann.  of  Surgery,  1907,  XXXXVI, 

86;  643,  1908,  XXXXVII,  506;  631. 

33.  Haig — Uric  Acid  as  a  Factor  in  the  Causa- 

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37.  Hutchinson — Food    and    Dietetics.    New 

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38.  IsENBERG — Monotschr.    f.    prakt.    Wasser- 

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39.  Janeway — Sajous'    Anal.    Cyclopedia    of 

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40.  JouNSON— Brit.  Med.  Jour.,  1900,  II,  982. 

41.  Jones — Arch.    Middlesex    Hosp.,  London, 

1911,  XXIII,  72. 

42.  Kahle — Munch.  Med.   Wochenschr.,  1914, 

LXI,  752. 

43.  Keith — Cancer :  Relief  of  Pain  and  Possible 

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45.  Kessler — Neiv  York  Medical  Journal,  1912, 

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46.  Lambe — Additional  Reports  on  the  Effects 

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1914,  CLXXI,  587. 

48.  Mayo,   W.   J. — Annals   of  Surgery,  1914, 

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49.  ]\IcCann — Starving  America.    New  York, 

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50.  McGregor— J5nY.  Med.  Jour.,  1900,  II,  982. 

51.  Merriam — St,  Louis  Courier  of  Med.,  1884, 

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1912,  XVIC,  378. 

52.  Mortality  Statistics,  Bureau  of  the  U.  S. 

Census,  1911,  1912. 

53.  Murphy's  Clinics,  Aug.  1912,  Dec.  1912, 

Aug.   1913,   Oct.   1913,  Dec.   1913,  Feb. 
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54.  NowELL — Xew  England  Med,  Gaz.,  1914, 

XLIX,  461. 

55.  Packard — Boston  Med.   and  Surg,  Jour., 

1912,  CLXVI,  452. 

56.  Paget — Lectures    on    Surgical    Pathology. 

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57.  Parker — Cancer.     New  York,  1885. 

58.  Reid — Cancer  Research  Laboratory,  Man- 

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also  1911,  I,  110. 

60.  Roberts — Lectures  on  Dietetics  and  Dys- 

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62.  RoHDENBURG,    BuLLOCK,    and    Johnson — 

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INDEX 


INDEX 


Abderhalden,  defensive  fer- 
ments in  cancer,  78 

Abernethy  on  vegetarian 
diet,   136 

Aborigines,  freedom  from 
cancer  of,  48,  llB 

Abstemiousness,  effect  on 
cancer,  139. 

Acid,  amino  nitrogen,  in- 
creased in  cancer,  91 

Acid  intoxication  in  can- 
cer, 77 

Acidosis  in  cancer,  80 

Acids,  oxyproteic,  in  the 
urine,  increased  in 
cancer,  90 

Addison's  disease,  97 

Adrenals,  relation  to  can- 
cer, 98 

Africa,  absence  of  cancer 
in,  50,  52 

Agamogenesis,  relation  to 
cancer,  72 

Age   affecting  cancer,   22 

Ages  of  patients  with  can- 
cer, 176 

Agnew  on  surgery  in  can- 
cer, 170 

Alcohol,  relation  to  can- 
cer, 120 

Alkalinity  of  blood,  dimin- 
islied  in  cancer,  77 

Amino-acid  nitrogen,  in- 
creased in  cancer,  91 

221 


Ammonia    fraction    of    ni- 
trogen,    increased     in 
cancer,  91 
Amylopsin  in  cancer,  99 
Anabolism  and  cancer,  33 
Anaemia  in  cancer,  74 
Animal    food    a    cause    of 
cancer,  50,  51,  52,  55, 
63,   69,   110,   113,   116, 
117,  132,  138,  141 
Animals,  cancer  in,  43 
Argentine  Republic,  cancer 

in,  57 
Australia,  cancer  in,  48 
Autointoxication  and  can- 
cer,   155 
Autonomous       action       of 
cells,  33 


Bainbridge,  local  nature  of 

cancer,  30 
Baltimore,  cancer  in,  65 
Banks,     Sfr    AYilliam,    on 

diet  in  cancer,  61 
Bashford,  55 
Beard,   trypsin   in   cancer, 

99 
Beatson's  operation,  102 
Beebe,  diet  and  cancer,  80 
Beirut,  rarity  of  cancer  in, 

56 
Bell,    cancer    from   neglect 

of  hygienic  laws,  132 
Beneke,  diet  in  cancer,  115 


222 


INDEX 


Benratt,  rarity  of  cancer 
in  India,  53 

Betel  chewing  cancer,  54 

Beidl,  hormone  formation, 
163 

Bio-chemistry  of  cancer, 
39,  79,  83 

Blood    changes    in    cancer, 
74,  191 
frequent     study     of,     in 
cancer,  160 

Blumenthal,  oxyproteic  ac- 
ids increased  in  can- 
cer, 90 

Boston,  cancer  in,  65 

Bowel  action  and  cancer, 
155,  157 

Braithwaite,    plainer    fare 
and  less  of  it,  154 
salt  and  cancer,   129 

Brazil,  rarity  of  cancer  in, 
57 

Breast,   carcinoma  of,   176 
non-cancerous  tumors  of, 
178 

Bristol,  disturbance  of 
chemical  equilibrium 
causing  cancer,  143 

British  Guiana,  rarity  of 
cancer  in,  50 

Burnham,  blood  changes 
in  cancer,  76 

Butter,  valuable  in  can- 
cer, 153 

Buttner,  a  fleshless  diet, 
154 

Cachexia  in  cancer,  74,  77 
Caffeine,   nitrogen   in,    119 
percentage  of,  in  coffee, 
119 
Cahen   on   Beatson's  oper- 
ation, 102 


Calcium  salts,  effect  on 
cancer,  101 

Cancer  in  the  occupied  and 
unoccupied,  130 
personal     statistics     of, 

176 
problem,  201 

Carcinoma,  personal  sta- 
tistics of,  174 

Casein  sometimes  allow- 
able in  cancer,  153 

Cases,  personal,  of  cancer, 
180-197 

Catabolism  and  cancer,  33 

Causes  of  cancer,  27 

Centrosomes  in  cancer,  34, 
85 

Cheese  sometimes  allow- 
able  in   cancer,    154 

Chemistry    of    cancer,    39, 
79,  83 
of  cancer  tissue,  78,  82 
of  the  body,  107 

Chicago,   cancer   in,   65 

China,  rarity  of  cancer  in, 
55 

Chittenden's  experiments 
on  nutrition,    112 

Chlorides  in  the  urine,  di- 
minished in  cancer,  92 

Cholesterin,  relation  to 
cancer,  83 

Chromosomes  in  cancer, 
85 

Civilization,  cancer  a  dis- 
ease of,  44,  46,  50,  68, 
109,   117 

Clinical  considerations,  170 
study  of   cancer,    17,    18 

Coffee,      consumption      in 
United  States,  118 
nitrogen  in,   119 
relation  to  cancer,  117 


INDEX 


223 


Cohnreicli,  blood  in  cancer, 

76 
Cold    storage,   relation   of, 

to  cancer,  10!) 
Composition      of      human 

body,  107 
Conclusions,  170,  203 
Constipation    and    cancer, 

157 
Contagiousness      excluded, 

19 
Cooper,  Sir  Astley  on  con- 
stitutional   nature    of 

cancer,  139 
Creoles  in  Africa,  freedom 

from  cancer  of,  52 
Cytology  of  cancer,  74 

Danger  from  thyroid  in 
cancer,  164 

Deaths  from  cancer  in  Xew 
York  City,  145 
in  United  States,  144 

De  Bloeme,  Swart,  and 
Terwen,  imperfect  ni- 
trogen partition  in 
cancer,  90 

Defective  urinary  excre- 
tion and  cancer,  158 

Deficiency  of  urinary  sol- 
ids in   cancer,   88 

Definition  of  cancer,  30 

Degrez,  imperfect  nitro- 
gen disintegration  in 
cancer,  91 

Denmark,  cancer   in,   82 

Demineralization  and  can- 
cer, 113 

Diabetes,  relation  of  to 
cancer,  95 

Diet,   effect   of    simple,   in 
cancer,  121 
relation    of,    to    cancer, 


46,  51,  53,  55,  57,  61, 
63,  67,  80,  106,  115, 
116,  133,  198 

Dietetic  treatment  of  can- 
cer, 171 

Disordered  metabolism  the 
cause  of  cancer,  74 

Ductless  glands  in  cancer, 
97 

Duration  of  cancer  before 
treatment,  177 

Early  treatment  of  cancer, 
medically,     147,     178, 
208 
surgically,  177 

Eating,  wrong-  and  over-, 
and  cancer,  152 

Egypt,  rarity  of  cancer  in, 
51,  57 

Ehrlich,  effect  of  diet  on 
cancer,  37 

Einhorn,  Kahn,  and  Rosen- 
blum,  imperfect  nitro- 
gen partition  in  can- 
cer, 90 

Embryonic  rests  in  cancer, 
23,  25,  72 

Endocrinous  glands,  rela- 
tion of,  to  cancer,  100 

England,  cancer  in,  51,  57, 
61 
increase  of  cancer,  with 
meat  consumption,  116 

Environmental  change  and 
cancer,  59 

Enzymes,  autolytic,  in  can- 
cer tissue,  83 

Equilibrium  of  tissue  ele- 
ments,  111 

Esmarck  and  Oldehop, 
vegetarian  diet  in 
cancer,  115 


224 


INDEX 


Etiology  of  cancer,  74 
Ewing,     change     in     polar 
axis    of    cells    m    can- 
cer, 34 
relation  of  chlosterin  to 
cancer,  83 

Far  East,  rarity  of  cancer 

in,  55,  56 
Fiji  Islands,  rarity  of  can- 
cer in,  50 
Fletcher,   imperfect   insali- 
vation  and  cancer,  94 
France,  cancer  in,  62 
Frequency  of  cancer,  43 
Functional       kidney       de- 
rangement    and     can- 
cer, 158 

Geographical    distribution 

of  cancer,  43 
"Germ  of  cancer,"  19 
Gigantism,  97 
Gout,    relation    to    cancer, 

72,  81 
Gratifying     the     taste,     a 

cause  of  cancer,  108 
Gruner,  toxicity  of  cancer 

juice,  78 
Gwyer,  thymus  feeding  in 

cancer,  101 

Haig,   cures   of   cancer   by 

dietary       restrictions, 

141 
uric    acid     and    cancer, 

125,   141 
narrower,       relation       of 

ductless      glands      to 

cancer,  97 
Heredity,  influence  of,  20 
Heterologous    elements    in 

cancer,  41 


Highest  cancer  mortality, 
62 

Hislop  and  Fenwick,  diet 
and   cancer,   50 

Holland,  high  cancer  mor- 
tality in,  118 

Hormones,  relation  of,  to 
cancer,  100 

Hormone  therapy  in  can- 
cer, 162 

Hungary,  low  cancer  mor- 
tality in,  118 

Hutchinson,  amount  of 
caffeine  in  tea  and 
coffee,  119 

Hygienic  laws,  neglect  of, 
a  cause  of  cancer,  132 

Hyperacidity  and  cancer, 
33 

Ichthyol  locally  in  cancer, 
166,  167 

Ideally  correct  blood 
stream  and  cancer, 
149 

Increase  of  cancer,  47 
in  the  United  States,  66 

Incurable  cancer,  140 

Independent  cell  action,  73 

Indians,  North  American, 
rarity  of  cancer  in,  67 

India,  rarity  of  cancer  in, 
53 

Infectious  diseases  and 
cancer,  29 

Inoperable  cancer,  146 

Insalivation,  thorough,  im- 
portance of  in  cancer, 
95 

Internal  secretions  in  can- 
cer, 96-103 

Intestinal  fermentation  in 
cancer,  92,   155 


INDEX 


225 


stasis  and  cancer,  155 
toxins  and  cancer,  155 

Intolerance  of  certain  ar- 
ticles a  cause  of  dis- 
ease, 127 

Intoxication,  intestinal, 
and  cancer,  155 

Iron,  value  of,  in  cancer, 
161 

Irritation,  local,  and  can- 
cer, 124 

Isenberg  on  vegetarian 
diet  in  cancer,  142 

Italy,  low  cancer  with  low 
meat  consumption,  63 

Jones,  blood  in  cancer,  76 

Kalile,  silica  retention  in 
cancer,  98 

"Kangri  burn"  cancer,  54, 
126 

Keith,  Skene,  iron  in  can- 
cer, 161 

Kellogg,  absence  of  cancer 
with  normal  metabo- 
lism, 151 

Kerry,  Ireland,  low  cancer 
mortality,  64 

Kessler,  sulphur  partition 
in  cancer,  122 

Kidneys,  faulty  excretion 
and  cancer,  157 

Korea,  rarity  of  cancer  in, 
57 

Laboratory  study  of  can- 
cer,  175,   191 

Lambe  on  vegetarian  diet, 
136 

Lane,  Sir  Arbuthnot,  in- 
testinal stasis  and 
cancer,  155 


Latham  on  cancer  of  the 
unoccupied,    61 

Leucocytosis  in  cancer,  75 

Lithaemia,  relation  to  can- 
cer, 72 

Liver,  condition  of  in  can- 
cer, 91 

Local   irritation    and   can- 
cer, 21,  124 
medical  treatment,   165 

Lott,  Beatson's  operation 
for  cancer,  102 

Lowest  cancer  mortality, 
60,  64 

Lucerne,   cancer  in,  62 

Luxurious  living  a  cause 
of  cancer,  68,  138,  199 

McCann,  erroneous  prepa- 
ration of  foods,  123 

McGregor,  absence  of  can- 
cer in  Fiji  Islands,  50 

Madden,  absence  of  cancer 
in  Africa,  50 

Malaria  and  cancer,  21 

Mastication,  thorough,  im- 
portance of  in  cancer, 
95 

Mayo,  acidity  and  cancer, 
124 

Meat       consumption,       in 
England,   116 
in  the  United  States,  69 

Meat,  relation  to  cancer, 
51,  53,  55,  57,  63,  116 

Medical  treatment  of  can- 
cer, 135,  154 

Melanesians,  exempt  from 
cancer,  50 

Mental    depression,     influ- 
encing cancer,  86 
strain,   relation   to   can- 
cer, 81,  85 


226 


INDEX 


Merriam,     meat     diet     a 

cause  of  cancer,  141 
Metabolism,         disordered, 

the  cause  of  cancer,  74 
of  cancer,  70 
perverted,     and     cancer, 

150 
Mineral     disturbances     in 

the  system  in  cancer, 

122 
Mitosis,    cell,    relation    to 

cancer,  85 
Mortality  from   cancer   90 

per  cent.,  144 
Murphy     on     surgery     in 

cancer,  171 
Myxoedema,  97 

Nature  of  cancer,  15,  29 
Negroes,   rarity   of   cancer 

in,  52,  67 
Nervous  strain,  relation  to 

cancer,  85 
New    York     City,     deaths 

from    cancer    in,     65, 

145 
negro    death    rate    from 

cancer,  67 
New  York  Skin  and  Can- 
cer Hospital,  8,  172 
New    Zealand,    cancer    in, 

50 
Nitrogen        disintegration, 

imperfect    in     cancer, 

91 
increase    in    colloid,    in 

cancer,  90 
partition   in    cancer,    90 
small  amount  needed  in 

the  economy,   114 
Nitrogenous  diet  and  can- 
cer, 51,  53,  55,  57,  63, 

81,  116 


Non-cancerous    tumors    of 

breast,  178 
Normal     body     cells     and 

cancer,  31,  41,  70 
Nowell,      serum     therapy, 

165 
Nuclei  of  cells,  in  cancer, 

84 
Nucleo-proteids  in   cancer, 

82 
Nutrition  and  cancer,  35, 

36 

Occupation  and  cancer,  28 
Ovaries,  internal  secretion 

of,  relation  to  cancer, 

102 
Over-eating  and  cancer,  152 
Over-indulgence,    effect   of, 

68 
Oxyproteic    a,cid,    relation 

to  cancer,  90 

Packard,  disturbance  of 
mineral  elements  in 
blood,  in  cancer,  122 

Paget,  Sir  James,  on  con- 
stitutional nature  of 
cancer,  140 

Paget's  disease,   174 

Pancreas,  relation  of,  to 
cancer,  98 

Parasitism  excluded,  19 

Paris,  cancer  in,  63 

Parker,  Willard,  on  con- 
stitutional cause  of 
cancer,  137 

Patience  required  for  med- 
ical treatment  of  can- 
cer, 134,  152 

Perseverance  required  for 
medical  treatment  of 
cancer,  134 


INDEX 


227 


Personal  cases  of  cancer, 
180-197 

Perverted  metabolism  and 
cancer,  74,  150 

Philadelphia,  cancer  in, 
65 

Philippines,  rarity  of  can- 
cer in,  57 

Phosphates  in  the  urine, 
diminished  in  cancer, 
94 

Pittsburgh,  cancer  in,  65 

Pituitary  secretion  in  can- 
cer,''97,  99 

Plants,  cancer  in,  43 

Plasma  of  blood  in  cancer, 
77 

Pluriglandular  extracts  in 
cancer,  164 

Polarity  of  cells  in  can- 
cer, 34,  73 

Polynesians,  exempt  from 
cancer,  50 

Potassium  acetate  in  can- 
cer, 159 
phosphate  in  cancer,  160 

Precancerous  conditions, 
89 

Prevention  of  cancer,  148 

Prize  fund  for  cure  of  can- 
cer, 173 

Problem  of  cancer,  201 

Prophylaxis  of  cancer,  148 

Prosperity  and  cancer,  48, 
68,  109 

Protein  foods,  harm  from, 
113 
metabolism,  disturbed  in 

cancer,  89 
requirement  of  the  body, 

112 
sufficient    in    vegetarian 
diet,  133 


Psoriasis,  lessons  from,  in 

cancer,  128 
Putrefaction,        intestinal, 

and  cancer,  155 

Radium,  value  in  cancer, 
29,    145,    168 

Recurrent  cancer,  146,  187- 
195 

Red  corpuscles  in  cancer, 
76,   77 

Refinement  of  food,  rela- 
tion of,  to  cancer,  109 

Reid,  increase  of  amino- 
acid  nitrogen  in  can- 
cer, 91 

Relation  of  diet  to  cancer, 
198 

Renner,  rarity  of  cancer 
among  Creoles,  51 

Requisites  for  development 
of  cancer,  25 

Rheumatism,  relation  to 
cancer,  72 

Ribert,  beginnings  of  can- 
cer, 30 

Roberts,  disturbance  of 
salivary  digestion 
from  tea,  119 

Robin,  relation  between 
chlorine  and  nitrogen 
in  cancer,  92 

Rohdenburg,  Bullock,  and 
Johnson,  thymus 
gland  in  cancer,   101 

Rome,  cancer  in,  63 

Ross,  thymus  and  calcium, 
harm  from  in  cancer, 
101 
relation  of  potash  salts 
to  cancer,   160 

Rous,  cancer  in  rats 
checked  by  diet,  39 


228 


INDEX 


Russian  oil  as  a  dressing 
in  cancer,  166 

Saaleby,  trypsin  and  amy- 
lopsin  in  cancer,  99 

St.  Louis,  cancer  in,  65 

Sajous,  adrenals  in  rela- 
tion to  cancer,  98 

Salivary  secretion,  acid  in 
cancer,  94,  95,  161 

Salt,  effect  of,  on  cancer, 
129 

Sarcoma  of  same  origin  as 
carcinoma,  175 

Scandinavia,  cancer  in, 
125 

Schmidt,  infectious  dis- 
eases and  cancer,  29 

Serum  therapy,  1G4 

Sherman,  composition  of 
the  human  body,  107, 
154 

Sherrington  and  Copeman, 
reproductive  glands  in- 
hibiting growth  of 
cancer,  103 

Shir  law,  pluriglandular 
extracts  in  cancer, 
163 

Silica,  retention  of,  in 
pancreas,  in  cancer, 
98 

Simple  diet,  effect  of,  in 
cancer,  121 

Soegaard,  stomach  cancer 
frequent  in  Norway, 
125 

Solids  in  the  urine,  defi- 
cient in  cancer,  87,  88 

Spontaneous  disap  p  e  a  r  - 
ance  of  cancer,  36 

Stasis,  intestinal,  and  can- 
cer, 155 


Stuart-Low,  relation  of 
thyroid  to  cancer,  100 

Sub-oxidation  and  cancer, 
132 

Sulphates,  increased  in 
cancer,  92 

Sulpho-cyanic  acid,  in- 
creased  in   cancer,   92 

Sulphur  elements,  altered 
in  cancer,  92 

Supra-renal  glands,  rela- 
tion of,  to  cancer,  97 

Surgery,  operative,  in  can- 
cer, 145,  147,  168,  179 

Surgical  aspects  of  cancer, 
7,  9,  10,  25 

Sweet,  Corson,  White,  and 
Saxon,  effect  of  diet 
on  experimental  tu- 
mors, 38 

Sw^itzerland,    cancer    in,  62 

Syphilis  and  cancer,  22 


Taste  gratified,  a  cause  of 
cancer,   108 

Tea,  relation  to  cancer, 
117 

Telluric  influences  in  can- 
cer, 22 

Testicles,  internal  secre- 
tion of,  relation  to 
cancer,   102 

Thompson  on  consumption 
of  coffee  and  tea,  118, 
154 

Thymus  gland  in  cancer, 
101 

Thyroid,    danger    from   in 
cancer,  164 
relation  to  cancer,  97 
value   of   in   cancer,   99, 
163 


INDEX 


229 


Tobacco,  influence  of,  in 
cancer,    126 

Toxicity  of  urine,  in- 
creased  in   cancer,   91 

Toxic  secretion  from  can- 
cerous mass,  70,  78, 
104,   206 

Toxins,  intestinal,  and  can- 
cer,  92,   155 

Transmission  of  cancer, 
20 

Traumatism  and  cancer, 
24 

Trypsin  in  cancer,   99 

Tuberculosis  and  cancer, 
IG,  44,  45 

Tuke,  influence  of  the 
mind  on  morbid  proc- 
esses, 80 

Turk,  CTtologT  of  cancer, 
74  ' 

United    States,    cancer    in, 
16,  64,  68 
consumption  of  cofi'ee  in, 

lis 

consumption  of  meat  in, 
117 

Urea  excretion,  deficient 
in  cancer  subjects, 
89 

Uricacidaemia,  relation  to 
cancer,    72 

Urinary  disturbance,  func- 
tional, and  cancer, 
158 

Urinary  solids,  deficient 
in  cancer,  87,  88 

Urobilin,  increased  in  can- 
cer,   90 

Vaccine  therapv  in  can- 
cer, 164 


Valais,  cancer  in,  62 

Vegetable  protein,  133 

Vegetable  tumors,  43 

Vegetarian  diet  afi'ords 
sufficient  protein,  133, 
153 

Vegetarian  diet  and  can- 
cer, 50-53,  55-57,  63, 
115,  123,  128,  136, 
142,  180-197 

Venus  on  vegetarian  diet 
in  cancer,   142 

Vincent,  quoting  Ehrlicli 
on  resistance  to  ath- 
reptic  infiuence,   163 

Vircliow,  on  tumor  forma- 
tion, 31 

Voit's  dietary  standard, 
111 

Volumetric  analysis  of 
urine  in  cancer,  87, 
94,   159 


Wakefield  on  hyperacidity 
of  the  blood  plasma  in 
cancer,    33 

Wales,  cancer  in,  57 

Walshe  on  the  cause  of 
cancer,    137 

Watson,  effect  of  meat 
diet  on  tissue  cells, 
114 

Wealth,  relation  to  cancer, 
48,  68,  109 

Weight  in  cancer,  161,  192, 
195 

Wells,  nuclear  proteins  in 
cancer  cells,  83 

Well-to-do  men  and  can- 
cer, 130 

West  Indies,  cancer  in,  57 

Williams,      cancer      prob- 


230 


INDEX 


lems,    36,   45,   47,    50,      Wrong  eating  and  cancer, 


58,  72 
Wolf,  cancer  in  Australia, 

47,  48 
Welter,  nucleo-proteids  in 

cancer  tissue,  82 


152 

Xanthin  bases,  increased 
in  cancer,  90,  91 

X-ray,  value  in  cancer,  29, 
145,   167 


MEDICAL  MONOGRAPHS 

PUBLISHED  BY 
PAUL  B.  HOEBER 

67-69  EAST  59th  St.,   NEW   YORK 

This  catalogue  comprises  only  our  ow-n  publications.  It 
zi'ill  be  noticed  that  particular  care  has  been  exercised  in  the 
selection  of  Monographs  of  timely  interest. 

IVe  are  akuays  glad  to  consider  the  publication  of  new  and 
original  medical  works.  Correspondence  with  Authors  is  in- 
vited. 

ADAM — Asthma  and  Its  Radical  Treatment.  By  James 
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pages,  Illustrated   $1.50  net. 

ARMSTRONG— I.  K.  Therapy,  With  Special  Reference  to 
Tuberculosis.  By  W.  E.  M.  Armstrong,  M.A.,  M.D. 
Dublin,  Bacteriologist  to  the  Central  London  Ophthalmic 
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pital for  Diseases  of  the  Skin.  Surgeon  to  the  Westminster 
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BIGG — Indigestion,  Constipation  and  Liver  Disorder.     By 

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BRUCE — Lectures  on  Tuberculosis  to  Nurses.     Based  on 
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HOEBER'8  MEDICAL  MONOGRAPHS 

BULKLEY — Compendium  of  Diseases  of  the  Skin.  Based 
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M.D.  Physician  to  the  New  York  Skin  and  Cancer  Hos- 
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BULKLEY — Cancer:    Its    Cause    and    Treatment.     By    L. 
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BULKLEY — Diet  and  Hygiene  in  Diseases  of  the  Skin. 

By  L.  Duncan  Bulkley,  A.M.,  M.D. 

8vo,  Cloth,  xvi+194  pages $2,00  nei^. 

BULKLEY— The  Influence  of  the  Menstrual  Function  on 
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BULKLEY— The  Relations  of  Diseases  of  the  Skin  to 
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BULKLEY — Principles  and  Application  of  Local  Treat- 
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CAUTLEY— The  Diseases  of  Infants  and   Children.     By 

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CORNET— Acute      General      Miliary      Tuberculosis.     By 

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2 


HOEBER'S  MEDICAL  MONOGRAPHS 

CROOKSHANK— Flatulence  and  Shock.     Bv  F.  G.  Crook- 
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EDRIDGE-GREEN — The  Hunterian  Lectures  on  Colour- 
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3rd,  191 1.  By  Professor  F.  W.  Edridge-Greex,  M.D.  Durh., 
F.R.C.S.  England.  Beit  Medical  Research  Fellow. 
8vo,   Cloth,  x+76  pages    $1.50   net. 

EHRLICH— Experimental  Researches  on  Specific  Thera- 
peutics. By  Prof.  Paul  Ehrlich,  }^I.D.,  D.Sc.  Oxon. 
Director  of  the  Konigliches  Institut  fiir  Experimentelle 
Therapie,  Frankfort.  The  Harben  Lectures  for  1907  of  The 
Royal  Institute  of  Public  Health. 
i6mo.  Cloth,  x-[-95  pages $1.00  net. 

EINHORN — Lectures    on    Dietetics.     By    ]\L'\x    Eixhorx, 
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Medical  School  and  Hospital  and  Visiting  Physician  to  the 
German  Hospital,  New  York. 
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ELLIOT — Sclero-Corneal  Trephining  in  the  Operative 
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LM.S.  Second  Edition.  8vo,  Cloth,  135  pages,  33  illustra- 
tions     $3-oo  «^^- 

EMERY — Immunity     and     Specific     Therapy.     By     Wm. 

D'EsTE  Emery,  ^I.D.,  B.Sc.  Lond.  Clinical  Pathologist  to 
King's  College  Hospital  and  Pathologist  to  the  Children's 
Hospital,  Paddington  Green;  formerly  Assistant  Bacteriolo- 
gist to  the  Royal  College  of  Physicians  and  Surgeons,  and 
sometime  Lecturer  on  Pathology  and  Bacteriology  in  the 
University  of  Birmingham. 

8vo,  Cloth,  448  pages,  with  2  ills $3.50  net. 

adopted  by  the  u.  s.  army 

GILES — Anatomy  and  Physiology  of  the  Female  Genera- 
tive Organs  and  of  Pregnancy.  By  Arthur  E.  Giles, 
I\r.D.,  B.Sc.  Lond.  M.R.C.P.  Lond.;  F.R.C.S.  Ed.  Gynecolo- 
gist to  the  Prince  of  Wales  General  Hospital,  Tottenham, 
and  Surgeon  to  the  Chelsea  Hospital  for  Women, 
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GREEFF — Guide  to  the  Microscopic  Examination  of  the 
Eye.  By  Professor  R.  Greeff.  Director  of  the  Uni- 
versity Ophthalmic  Clinique  in  the  Royal  Charity  Hospital, 
Berlin.    With  the  co-operation  of  Professor  Stock  and  Pro- 

3 


HOEBER'S  MEDICAL  MONOGRAPHS 

FESSOR  WiNTERSTEiNER.     Translated  from  the  third  German 
Edition  by  HuG»  Walker,  M.D.,  M.B.,  CM.     Ophthalmic 
Surgeon  to  the  Victoria  Infirmary,  Glasgow. 
Large  8vo,  Cloth,  86  pages,  Illustrated  $2.00  net. 

HARRIS — Lectures  on  Medical  Electricity  to  Nurses.     An 

Illustrated  Manual  by  J.  Delpratt  H.\rris,  M.D.  Durh., 
]\I.R.C.S.  Senior  Surgeon  and  Honorary  Medical  Officer 
in  charge  of  the  Electrical  Department,  Royal  Devon  Hosp. 
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HOFMANN-GARSON— Remedial  Gymnastics  for  Heart 
Affections.  Used  at  Bad-Nauheim.  Being  a  translation 
of  "Die  Gymnastik  der  Herzleidenden"  von  Dr.  Med. 
Julius  Hofmann  und  Dr.  Med.  Ludwig  Pohlman.  Berlin 
and  Bad-Nauheim.  By  John  George  Garson,  M.D.  Edin., 
etc.  Physician  to  the  Sanatoria  and  Bad-Nauheim,  Evers- 
ley,  Hants.  With  51  full-page  illustrations  and  diagrams. 
Large  8vo,  Cloth,  xvi+i^S  pages   $2.00  net. 

HOWARD— The   Therapeutic   Value   of   the   Potato.    By 

Heaton  C.  Howard,  L.R.C.P.  Lond.,  M.  R.  C.  S.  Eng.  8vo, 
paper,  vi-|-3i  pages,  Illustrated  50c 

JELLETT— A   Short    Practice   of  Midwifery   for   Nurses. 

Embodying  the  treatment  adopted  in  the  Rotunda  Hospital, 
Dublin.  By  Henry  Jellett,  B.A.,  M.D.  (Dublin  Univer- 
sity) F.R.C.P.I.,  Master  Rotunda  Hospital;  Extern  Exam- 
iner in  Midwifery  and  Gynecology,  Victoria  University, 
Manchester;  Late  King's  Professor  of  Midwifery;  Univer- 
sity of  Dublin.  With  six  plates  and  169  illustrations  in  the 
text,  also  an  appendix,  a  glossary  of  Medical  Terms,  and 
the  Regulations  of  the  Central  Midwives  Board. 
i2mo.  Cloth,  xvi-[-5o8  pages  $2.50  net. 

KENWOOD— Public      Health      Laboratory      Work.      By 

Henry  R.  Kenwood,  M.B.,  F.R.S.  Edin.,  P.P.H.,  F.C.S., 
Chadwick.  Professor  of  Hygiene  and  Public  Health,  Uni- 
versity of  London;  Medical  Officer  of  Health  and  Public 
Analyst  for  the  Metropolitan  Borough  of  Stoke  Newington; 
Examiner  in  Public  Health  to  the  Royal  College  of  Phy- 
sicians and  Surgeons,  London,  etc. 
6th  Edition,  8vo,  Cloth,  418  pages.     Illustrated $4.00  net. 

LEWERS — A  Practical  Textbook  of  the  Diseases  of 
Women.  By  Arthur  H.  N.  Lewers,  M.D.  Lond.  Senior 
Obstetric  Physician  to  the  London  Hospital;  Late  Exam- 
iner in  Obstetric  Medicine  at  the  University  of  London; 
University  Scholar  &  Gold  Medallist  in  Obstetric  Medicine, 
London  University,  etc.  With  258  illustrations,  13  colored 
plates,  5  plates  in  black  and  white. 

7th  Edition,  8vo,  Cloth,  xii+540  pp $4.00  net. 

4 


IIOEBER'S  MEDICAL  MONOGRAPHS 

LEWIS— Clinical  Disorders  of  the  Heart  Beat.  A  Hand- 
book for  practitioners  and  Students.  By  Thomas  Lewis, 
M.D.,  D.Sc,  F.R.C.P.  Assistant  Physician  and  Lecturer  in 
Cardiac  Pathology,  University  College  Hospital,  Physician 
to  Out-Patients,  City  of  London  Hospital  for  Diseases  of 
the  Chest.  SECOND  EDITION. 
8vo,  Cloth,   ii6  pages.     Illustrated    $2.00  net. 

LEWIS — Lectures  on  the  Heart.  Coinprising  the  Herter 
Lectures  (Baltimore),  a  Harvey  Lecture  (New  York)  and 
an  address  to  the  Faculty  of  ^ledicine  at  AIcGill  Univer- 
sity (^lontreal),  by  Thomas  Lewis,  M.D.,  F.R.C.P.  Phy- 
sician, City  of  London  Hospital;  Assistant  Physician  and 
Lecturer  in  Cardiac  Patholog>%  University  College  Hos- 
pital, London.     With  83  illustrations $2.00  net. 

LEWIS— The  Mechanism  of  the  Heart  Beat.  With  spe- 
cial reference  to  its  Clinical  Pathology.  By  Thomas  Lewis, 
M.D.,  D.Sc,  ^I.R.C.P.  Lecturer  in  Cardiac  Pathology,  Uni- 
versity College  Hospital  Medical  School;  Physician  to  Out- 
Patients,  City  of  London  Hospital  for  the  Diseases  of  the 
Chest.     Large  8vo,  Cloth,  295  pages,  227  Illus $7.00  net. 

McCLURE — A    Handbook    of    Fevers.     By    J.    Campbell 
AIcClure,  ]\I.D.,  Glasgow.     Physician  to  Out-Patients,  The 
French  Hospital,  and  Physician  to  the  iMargaret  Street  Hos- 
pital for  Consumption  and  Diseases  of  the  Chest,  London. 
8vo,  Cloth,  470  pages,  with  charts   $3.50  net. 

McCRUDDEN— The   Chemistry,   Physiology  and  Pathol- 
ogy  of    Uric   Acid,   and   the    Physiologically    Important 
Purin   Bodies.     With    a    discussion    of   the    Aletabolism    in 
Gout.     By  Francis  H.  jMcCrudden, 
i2mo,  Paper.     318  pages   $2.00  net. 

McKISACK — Systematic-Case  Taking.     A   Practical  guide 
to    the    examination    and    recording    of    medical    cases.     By 
Hexry  Lawrence  AIcKisack,  ]\I.D.,  ]\I.R.C.P.  Lond.     Phy- 
sician to  the  Royal  Victoria  Hospital,  Belfast. 
i2mo,  Cloth,  166  pages  $1.50  net. 

MACKENZIE — Symptoms    and   their    Interpretation.     By 

James  Mackenzie,  M.D.,  LL.D.,  Aber.  and  Edin.     Lecturer 

on  Cardiac  Research,  London  Hospital. 

8vo,  Cloth.     Illustrated.     xxii-]-304  pages   $3.00  nei>. 

MACMICHAEL— The  Gold-Headed  Cane.  By  William 
Macmichael.  Reprinted  from  the  2nd  Edition.  With  a 
Preface  by  Sir  William  Osler  and  an  Introduction  by  Dr. 
Francis  R.  Packard. 

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5 


IIOEBER'S  MEDICAL  MONOGRAPHS 

MARTINDALE     and     WESTCOTT— "Salvarsan"     "606" 
(Dioxy-Diamino    Arsenobenzol)     Its    Chemistry,    Phar- 
macy and  Therapeutics.     By  W.   Harrison   Martindale, 
Ph.D.  Marburg  F.C.S.,  and  W.  Wynn  Westcott,  M.B. 
8vo,  Cloth,  xvi+76  pages $1.50  net. 

MINETT — Diagnosis    of    Bacteria    and    Blood    Parasites. 

By  E.  P.  MiNETT,  M.D.,  D.P.H.,  D.T.M.  and  H.,  M.R.C.S., 
L.R.C.P.     Assistant  Government  Medical  Officer  of,  Health 
and  Bacteriologist  British  Guiana. 
i2mo,   Cloth,   viii+80  pages    $1.00   net. 

MOTT — Nature  and  Nurture  in  Mental  Development.     By 

F.  W.  MoTT,  M.D.,  F.R.S.,  F.R.C.P.  Pathologist  to  the 
London  County  Asylums,  Consulting*  physician  to  Charing 
Cross  Hospital  and  the  Queen  Alexandra  Military  Hospital. 
i2mo,  Cloth,  151  pages,  with  Diagrams $1.50  net'. 

MURRELL— What    to    do    in    Cases    of    Poisoning.     By 

William  Murrell,  M.D.,  F.R.C.P.  Senior  Physician  to 
the  Westminster  Hospital;  Lecturer  on  Clinical  Medicine 
and  joint  lecturer  on  the  principles  and  practice  of  medi- 
cine ;  Late  examiner  in  the  Universities  of  Edinburgh,  Glas- 
gow and  Aberdeen,  and  to  the  Royal  College  of  Physicians. 
Eleventh  Edition,  i6mo,  Cloth,  283  pages $1.00  net. 

OLIVER — Lead  Poisoning:  From  the  Industrial,  Med- 
ical and  Social  Point  of  View.  Lectures  delivered  at  the 
Royal  Listitute  of  Public  Health.  By  Sir  Thomas  Oliver, 
M.A.,  M.D.,  F.R.C.P.  Consulting  Physician,  Royal  Victoria 
Infirmary,  and  Professor  of  the  Principles  and  Practice  of 
Medicine,  University  of  Durham  College  of  Medicine,  New- 
castle-upon-Tyne, Late  Medical  Expert,  Dangerous  Trades 
Committee;  Home  Office. 
Large  i2mo,  Cloth,  294  pages $2.00  net. 

OSLER— Two  Essays.  By  Sir  William  Osler,  M.D. 
Regius  Professor  of  Medicine  at  Oxford. 

Vol.  I.  A  Way  of  Life.  An  Address  to  Yale  Students, 
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OTT — Fever,  Its  Thermotaxis  and  Metabolism.  By  Isaac 
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Chirurgical  College  of  Philadelphia ;  Ex-Fellow  in  Biology 
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6 


HOEBER'S  MEDICAL  MONOGRAPHIC 

PAGET — For  and  Against  Experiments  on  Animals.  Evi- 
dence before  the  Royal  Commission  of  Vivisection.  By 
Stephen  Paget,  F.R.C.S.  Hon.  Secretary  Research  De- 
fence Society.  With  an  introduction  by  The  Right  Hon. 
THE  EARL  OF  CROMER,  O.M.,  G.C.M.G.,  G.C.B. 
8vo,  Cloth,  Illustrated.     xii-|-344  pages   $1.50  net. 

PEGLER — Map  Scheme  of  the  Sensory  Distribution  of  the 
Fifth  Nerve  (Trigeminus)  with  Its  Ganglia  and  Connec- 
tions. By  L.  Hemington  Pegler,  ]\I.D.,  M.R.C.S.  Senior 
Surgeon,  Metropolitan  Ear,  Nose  and  Throat  Hospital,  Etc. 

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RAWLING — Landmarks  and  Surface  Markings  of  the  Hu- 
man Body.  By  L.  Bathe  Ramming,  M.B.,  B.C.  (Cant.) 
F.R.C.S.  (Lond.)  Surgeon  with  charge  of  Out-Patients, 
Late  Senior  Demonstrator  of  Anatomy  at  St.  Bartholomew's 
Hospital;  Late  Assistant-Surgeon  to  the  German  Hospital, 
Dalston;  Late  Hunterian  Professor  Royal  College  of  Sur- 
geons, England,  Etc.  FIFTH  EDITION. 
Svo,  Cloth,  31  plates,     xii+96  pages  of  text $2.00  net. 

RITCHIE— Auricular  Flutter.  By  William  Thomas 
Ritchie,  M.D.,  F.R.C.P.E.,  F.R.S.E.  Physician  to  the 
Royal  Infirmary ;  Lecturer  on  the  Practice  of  Medicine, 
School  of  Medicine  of  the  Royal  Colleges ;  Lecturer  on 
Clinical  Medicine  in  the  University  of  Edinburgh.  Large 
Svo,  Cloth,  xii4-i44  pages,  21  plates,  107  illus $3.50  net. 

RUTHERFORD— The     Ileo-Caecal     Valve.     By     A.     LL 

Rutherford,  M.D.     Edin. 

Svo,  Cloth,  62,  pages  of  text,  23  full  page  plates,  3  of  which 

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SAALFELD — Lectures  on  Cosmetic  Treatment.  A  Man- 
ual for  Practitioners.  By  Dr.  Edmund  Saalfeld  of  Berlin. 
Translated  by  J.  F.  Dally,  M.A.,  M.D.,  B.C.  Cantab., 
M.R.C.P.  Lond.  Physician  to  the  St.  Marylebone  General 
Dispensary,  With  an  introduction  and  notes  by  P.  S. 
Abraham,  M.A.,  M.D.,  B.Sc,  F.R.C.S. I.,  Surgeon  for,  and 
Lecturer  on.  Diseases  of  the  Skin,  West  London  Hospital 
and  College.  Late  Surgeon  to  the  Skin  Hospital  Blackfriars. 
i2mo,  Cloth,  xii-l-i86  pages.  Illustrated   $i-75  w^^- 

SCOTT— The  Road  to  a  Healthy  Old  Age.  Essays  by 
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SENATOR  and  KAMINER— Marriage  and  Disease.  Be- 
ing an  Abridged  Edition  of  "Health  and  Disease  in  Rela- 
tion to  Marriage  and  the  Married  State."  By  Professor 
H.  Senator  and  Dr.  S.  Kaminer.  Translated  from  the 
German  by  J.  Dulberg,  M.D. 

Svo,  Cloth,  452  pages $2.50  net. 

7 


HOEBEB'S  MEDICAL  MONOGRAPHS 

SMITH — Some  Common  Remedies,  and  Their  Use  in 
Practice.  By  Eustace  Smith,  M.D.  Fellow  of  the  Royal 
College  of  Physicians ;  Senior  Physician  to  the  East  Lon- 
don Hospital  for  Children ;  Consulting  Physician  to  the 
Victoria  Park  Hospital  for  Diseases  of  the  Chest. 
8vo,  Cloth,  viii+ii2  pages $1.25  net. 

SQUIER  and   BUGBEE— Manual   of  Cystoscopy.     By  J. 
Bently   Squier,    M.D.     Professor   of   Genito-Urinary   Sur- 
gery, New  York  Post-Graduate   Medical   School  and  Hos- 
pital, and  Henry  G.  Bugbee,  M.D. 
8vo,  Flex.  Leather,  xiv-f-117  pp.,  26  colored  plates. $3.00  net. 

ADOPTED  BY  THE  U.   S.  ARMY 

STARK— The  Growth  and  Development  o£  the  Baby.    A 

tabular  chart,  giving  the  result  of  personal  observation, 
verified  by  authoritative  data,  as  to  development,  weight, 
height,  etc.,  during  the  first  seven  years.  By  Morris 
Stark,  M.A.,  B.S.,  M.D.  Instructor  of  Pediatrics,  New 
York  Post  Graduate  Medical  School,  etc. 
Heavy  paper,  20  by  25  inches  50c  net. 

STEPHENSON— Eye-Strain   in    Every-day   Practice.     By 

Sidney     Stephenson,     M.B.,     CM.     Edin.,     D.O.     Oxon, 
F.R.C.S.   Edin.     Ophthalmic   Surgeon  to  the  Queens   Hos- 
pital for  Children ;  Editor  of  the  Ophthalmoscope. 
8vo,  Cloth,  X+139  pages $1.50  net. 

STEPHENSON— A  Review  of  Hormone  Therapy.     191 3 

8vo,  Cloth,  viii+170  pages $1.00  net. 

Bound  and  interleaved  edition  of  the  famous  "Hormone 
Number"  of  the  "Prescriber"  (Edinburgh). 
SWIETOCHOWSKI— Mechano-Therapeutics  in  General 
Practice.  By  G.  de  Swietochowski,  M.D.,  M.R.C.S,  Fel- 
low of  the  Royal  Society  of  Medicine;  Clinical  Assistant, 
Electrical  and  Massage  Department  King's  College  Hosp. 
i2mo,  Cloth,  xiv+141  pp.,  31  Illustrations  $1.50  net 

TURNER  and  PORTER— The  Skiagraphy  of  the  Acces- 
sory Nasal  Sinuses,  By  A.  Logan  Turner,  M.D., 
F.R.C.S. E.,  F.R.S.E.  Surgeon  to  the  Ear  and  Throat  De- 
partment, The  Royal  Infirmary,  Edinburgh,  and  W.  G. 
Porter,  M.B.,  B.Sc,  F.R.C.S. E.  Surgeon  to  the  Eye  and 
Throat  Infirmary,  Edinburgh. 
Quarto,  Cloth,  45  pages  of  text.     39  plates $4.50  net. 

WANKLYN — How  to  Diagnose  Smallpox.  A  Guide  for 
General  Practitioners,  Post-Graduate  Students  and  Others. 
By  W.  McC.  Wanklyn,  B.A.,  Cantab.,  M.R.C.S.,  L.R.C.P., 
D.P.H.  Assistant  Medical  Officer  of  the  London  County 
Council  and  formerly  Medical  Superintendent  of  the  River 
Ambulance  Service  (Small-pox). 
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HOEBER'S  MEDICAL  MONOGRAPHS 

WHITE— The     Pathology     of     Growth.      Tumours.      By 

Charles  Powell  White,  M.C,  F.R.C.S.     Director,  Pilking- 
ton   Cancer   Research   Fund,   Pathologist   Christie   Hospital, 
Special  Lecturer  in  Pathology,  University  of  Manchester. 
8vo,  Cloth,  xvi-[-235  pages.     Illustrated  $3.50  ^let. 

WATSON — Gonorrhoea  and  its  Complications  in  the 
Male  and  Female.  By  David  Watson,  M.B.,  CM.,  Sur- 
geon Glasgow  Lock  Hospital,  Dispensary  Surgeon  for  Ve- 
nereal Diseases  Glasgow  Royal  Infirmary,  etc.,  etc. 
8vo,  Cloth,  375  pages,  72  illustrations,  12  plates,  some  col- 
ored   $3«75  '^^^i- 

WICKHAM  and  DEGRAIS— Radium.  As  employed  in 
the  treatment  of  Cancer,  Angiomata,  Keloids,  Local  Tuber- 
culosis and  other  affections.  By  Louis  Wickham,  M.V.O. 
iMedecin  de  St,  Lazare ;  Ex-Chef  de  Clinique  a  L'Hopital 
St.  Louis,  and  Paul  Degrais,  Ex-Chef  de  Laboratoire  a 
L'Hopital  St.  Louis.  Chefs  de  service  au  Laboratoire 
Biologique  du  Radium ;  Laureats  de  L'Academie  de  Medi- 
cine. 
8vo,  Cloth,  53  illustrations,  viii+iii   pp $1.25  net. 

WRENCH— The      Healthy     Marriage.     A     Medical     and 
Psychological  Guide  for  Wives.     By  G.  T.  Wrench,  M.D., 
B.S.     Lond.     Past  Assistant   Master  of  the  Rotunda   Hos- 
pital, Dublin. 
8vo,  Cloth,  x+300  pages  $1.50  net. 

WRIGHT— The  Unexpurgated  Case  against  Woman 
Suffrage.  By  Sir  Almroth  E.  Wright,  M.D.,  F.R.S. 
8vo,  Cloth,  xii-|-i88  pages  $1.00  iiet. 

WRIGHT— On  Pharmaco-Therapy  and  Preventive  In- 
oculation; Applied  to  Pneumonia  in  the  African  Native 
with  a  discourse  on  the  Logical  Methods  which  ought  to  be 
Employed  in  the  Evaluation  of  Therapeutic  Agents.  By 
Sir  Almroth  E.  Wright,  M.D.,  F.R.S. 
8vo,  Cloth,  124  pages   $i'75  ^^et. 

Complete  catalogue  and  descriptive  circulars  will  be  sent  on 

request. 


